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Performance Improvement 2000

Publication Date
Dec 31, 1999

Foreword

Performance Improvement 2000: Evaluation Activities of the U.S. Department of Health and Human Services is the sixth annual report to Congress summarizing previous fiscal year evaluation efforts. The purpose of this report is to provide Congress with evaluative information on the Department’s programs, policies, activities, and strategies. It contains brief summaries of evaluation results and provides a federal agency contact name for obtaining more detailed information. The report is useful to health and human service researchers, stakeholders and practitioners who use the information to assist their work.

In the era of results-oriented management, evaluations are playing an increasingly important role in program improvement. To this end, the Department of Health and Human Services (HHS) is committed to ensuring its evaluations yield valuable knowledge, and that knowledge is used to improve program performance. This is a consistent theme of our annual reports. Evaluations summarized in this report contribute to program improvement in four ways.

Program effectiveness studies provide a way to determine the impact of HHS programs on achieving intended goals and objectives. In fiscal year 1999, the Centers for Disease Control and Prevention (CDC) evaluated its Prevention Marketing Initiative, a 5-year demonstration of social marketing techniques combined with community participation, to reduce the risk of AIDS in young people. In selected sites, the demonstration proved successful in changing attitudes, knowledge, and sexual behavior of high risk teenagers. Recommendations for replicating the prevention model in other communities are an important contribution of the evaluation.

Performance measurement is the primary mechanism used to monitor annual progress in achieving departmental strategic and performance goals. To support performance measurement, HHS agencies are investing evaluation funds to develop and improve performance measurement systems and the quality of the data that supports those systems. For example, the Agency for Healthcare Research and Quality (AHRQ) created an inventory of clinical, population, and system performance measures for the purposes of identifying gaps and overlaps in measures and better coordinate their use.

Environmental assessment is the way we understand the forces of change in the health and human services environment that will influence the success of our programs and the achievement of our goals and objectives. In turn, this understanding allows us to adjust our strategies and continue to deliver effective health and human services. The Health Resources and Services Administration (HRSA) studied patient enrollment and assignment policies of Medicaid managed care plans on federally-qualified health centers to better understand issues for access to care for uninsured persons and healthcare quality.

Program management reflects the need of program managers to obtain information or data helpful for effectively designing and managing a program. These evaluations generally focus on developmental or operational aspects of program activities and provide understanding of services delivered and populations served. The National Institutes of Health (NIH) surveyed research grant applicants to measure their satisfaction with NIH's grant application and review process. Respondents offered suggestions for improving grant application forms and submission practices, use of electronic submissions, use of more expert reviewers, and ways to reduce waiting times.

Performance Improvement 2000 contains information on HHS evaluation projects completed and in progress during fiscal year (FY) 1999. The report is organized into three chapters. Chapter I provides an overview of HHS uses of evaluation, resources, planning, quality control and dissemination. Chapter II highlights the results from six FY 1999 evaluations, selected by an outside review panel as outstanding for their potential use by the larger health and human services community. Chapter III presents summaries of all FY 1999 evaluations completed and in progress by the 11 HHS agencies and the Office of the Secretary. The criteria used by the Evaluation Review Panel to select the reports highlighted in chapter II are presented in the Appendix.

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

Donna E. Shalala
Secretary
U.S. Department of Health
      Margaret A. Hamburg, M.D.
Assistant Secretary for
   Planning and Evaluation

Acknowledgments

Performance Improvement 2000: Evaluation Activities of the U.S. Department of Health and Human Services describes the continuous efforts of the various HHS agencies to examine service and research programs for the efficiency of their operations and their effectiveness in achieving objectives. The planning, development, and coordination of those evaluations is largely the responsibility of the following HHS planning and evaluation offices:

Administration for Children and Families
Office of Planning, Research and Evaluation
Howard Rolston, Director
 
Administration on Aging
Office of Program Operations and Development
Edwin Walker, Director
 
Agency for Health Care Policy and Research
Office of the Administrator
Lisa Simpson, Deputy Administrator
 
Agency for Toxic Substances and Disease Registry
Office of Policy and External Affairs
Georgi A. Jones, Director
 
Centers for Disease Control and Prevention
Office of Program Planning and Evaluation
Kathy Cahill, Director
 
Food and Drug Administration
Office of Planning and Evaluation
William K. Hubbard, Associate Commissioner
 
Health Care Financing Administration
Office of Strategic Planning
Barbara S. Cooper, Director
 
Health Resources and Services Administration
Office of Planning, Evaluation and Legislation
Paul W. Nannis, Director
 
Indian Health Service
Office of Public Health
Elizabeth A. Fowler, Director
 
National Institutes of Health
Office of Science Policy and Technology Transfer
Lana Skirboll, Associate Director
 
Office of the Assistant Secretary for Planning and Evaluation
Office of Program Systems
Delores Parron, Deputy Assistant Secretary for Program Systems
 
Office of Public Health and Science
Randolph F. Wykoff, Deputy Assistant Secretary for Health
(Disease Prevention and Health Promotion)
 
Substance Abuse and Mental Health Services Administration
Office of Policy and Program Coordination
Daryl Kade, Director
 

Preparation of this report and the noted appendices was coordinated by staff in the Office of the Assistant Secretary for Planning and Evaluation, under the supervision of Delores Parron, Deputy Assistant Secretary for Program Systems. Responsible staff include Mike Herrell, Paul Johnson, and Carolyn Solomon. Development and production of the report was supported, under contract, by the services of Susan Belsinger and Marilyn Henry of Sanad Support Technologies, Inc.; Reid Jackson, Wayne Hall, and Carolyn Paxton of the South Carolina State University Policy Analysis Consortium. The following persons from HHS agencies contributed to writing, collecting information on evaluation activities, and reviewing the report:

Administration for Children and Families
Mary Ann MacKenzie
James V. Dolson
 
Administration on Aging
David Bunoski
 
Agency for Health Care Policy and Research
Elizabeth Levell
Wendy Perry
 
Agency for Toxic Substances and Disease Registry
David Evans
Donna McKissick-Jones
 
Centers for Disease Control and Prevention
Nancy Cheal
Nancy Chalmers
 
Food and Drug Administration
Kathleen McEvoy
Mary Bobolis
 
Health Care Financing Administration
William Saunders
Sydney Galloway
 
Health Resources and Services Administration
Roger Straw
Willine Carr
 
Indian Health Service
Debbie Melton
 
National Institutes of Health
John Uzzell
Diane Buckley
Joan Bailey
 
Office of Public Health and Science
Linda Meyers
Valerie Welsh
 
Substance Abuse and Mental Health Services Administration
George Fitzelle
 

Evaluation Review Panel

The following individuals served on the evaluation review panel that made recommendations of the reports highlighted in chapter II of Performance Improvement 2000: Evaluation Activities of the U.S. Department of Health and Human Services.

Daudi Ajani ya Azibo, Ph.D.
Department of Psychology
Florida A&M University
Tallahassee, Florida.
 
Douglas Barnett, Ph.D.
Department of Psychology
Wayne State University
Detroit, Michigan
 
Heather Becker, Ph.D.
Professor, School of Nursing
University of Texas
Austin, Texas
 
Anna Madison, Ph.D.
University of Massachusetts at Boston
Human Services Graduate Program
Boston, MA
 
Holly Korda, Ph.D., Panel Chair
Evaluation Consultant
Chevy Chase, Maryland
 
John Kralewski, Ph.D.
Director, Institute for Health Services Research
School of Public HealthUniversity of Minnesota
Minneapolis, Minnesota
 
Kenneth McLeroy, Ph.D.
School of Rural Public Health
Texas A&M University
College Station, Texas
 
Donna Mertens, Ph.D.
Professor
Gallaudet University
Washington, D.C.
 
Felix A. Okojie, Ph.D.
Jackson State University
Jackson, Mississippi
 
Mary Ann Scheirer, Ph.D.
Evaluation and Social Research Consultant
Annandale, Virginia

Chapter I. Evaluation in the Department of Health and Human Services

Evaluation plays an integral role in carrying out the HHS mission. Assessing various aspects of agency program performance allows staff to identify means of improving that performance. The HHS evaluation function has three goals: (1) to provide information on HHS programs that helps government officials and members of the Congress make decisions related to programs, policies, budgets, and strategic planning; (2) to help HHS managers improve program operations and performance; and (3) to disseminate evaluation results and methodological tools useful to the larger health and human services community of State and local officials, researchers, advocates, and practitioners for improving the performance of their programs.

This chapter describes the organization and operation of evaluation at HHS. It first provides a working definition of evaluation and the various types of studies or projects supported by HHS agencies. Following is a description of the resources and funding mechanisms used to support evaluations. The remaining chapter sections provide details on various aspects of the management of HHS evaluation activities, such as the role played in departmental planning initiatives, how evaluation projects are managed; how HHS agencies ensure technical quality of evaluation projects, and promote effective dissemination and use of evaluation results.

Definition of Evaluation at HHS

HHS defines evaluation as the assessment of the performance (efficiency, effectiveness, and responsiveness) of HHS programs or strategies through the analysis of data or information collected systematically and ethically, and the effective use of resulting information in strategic planning, program or policy decision making and program improvement. Evaluations conducted by HHS agencies generally serve one or more of the following purposes:

Program effectiveness provides a way to determine the impact of HHS programs on achieving intended goals and objectives.

Performance measurement is the primary mechanism used to monitor annual progress in achieving departmental strategic and performance goals. To support performance measurement, we are investing evaluation funds to develop and improve performance measurement systems and the quality of the data that supports those systems.

Environmental assessment is the way we understand the forces of change in the health and human services environment that will influence the success of our programs and the achievement of our goals and objectives. In turn, this understanding allows us to adjust our strategies and continue to deliver effective health and human services.

Program management reflects the need of program managers to obtain information or data helpful for effectively designing and managing a program. These evaluations generally focus on developmental or operational aspects of program activities and provide understanding of services delivered and populations served.

Evaluation Resources

Evaluation activities of the various HHS agencies are largely supported through two funding mechanisms: direct use of program funds and use of special legislative set-aside authorities for evaluation. The first is a common mechanism by which programs managers have discretionary authority to use appropriated program funds to support contracts that will design, implement, and analyze evaluation data. In some cases, a program’s legislative authority calls for a specially mandated evaluation, and program funds are used directly to support the evaluation.

The second mechanism for evaluation funding is the legislative set-aside authority which permits the Secretary of HHS to use a proportion of overall program funds for evaluation purposes. The largest of such set-aside authorities at HHS is one established for evaluations conducted by several agencies of the U.S. Public Health Service (AHRQ, CDC, HRSA, NIH, and SAMHSA), ASPE, and the Office of Public Health and Science (OPHS) in the Office of the Secretary. The mechanism is called the 1-percent evaluation set-aside legislative authority, which is provided for in Section 241 of the Public Health Service (PHS) Act. This authority was established in 1970, when the Congress amended the Act to permit the HHS Secretary to use up to 1 percent of appropriated funds to evaluate authorized programs. Section 241 limits the base from which 1 percent of appropriated funds can be reserved for evaluations of programs authorized by the PHS Act. Excluded are funds appropriated for FDA, IHS1, and certain other programs that are managed by PHS agencies but not authorized by the Act (e.g., HRSA’s Maternal and Child Health Block Grant and CDC’s National Institute for Occupational Safety and Health). In FY 2000, HHS invested more than $39 million in 1-percent evaluation funds to carry out evaluation activities related to relevant public health programs. The FY 2000 Labor, HHS, and Education Appropriations Act provided that an additional $160.2 million in 1-percent evaluation funds be used to support data collection and analysis activities in AHCPR and CDC’s National Center for Health Statistics.

Evaluation Management

The management of HHS evaluations, which are carried out on a regular basis by the HHS agencies and offices and coordinated by ASPE, involves four basic functions: (1) evaluation planning and coordination, (2) project management, (3) quality assurance, and (4) dissemination of evaluation reports. A description of each function in general terms follows.

Evaluation Planning and Coordination

The HHS agencies, ASPE, the Office of the Inspector General (OIG), and OPHS develop evaluation plans annually in concert with HHSs program planning, legislative development, and budgeting cycles. Plan development is coordinated by ASPE. Each agency or office plan generally states the evaluation priorities, or projects under consideration for implementation. Typically, HHS evaluation priorities include: congressionally-mandated program evaluations, evaluations of Secretarial program or policy initiatives, assessments of new programs and ones that are candidates for reauthorization, and evaluations that support program performance management and accountability.

More specifically, HHS evaluation planning activities are coordinated with three department-wide planning initiatives: (1) strategic planning and performance management according to the Government Performance and Results Act (GPRA) of 1993; (2) annual research, demonstration and evaluation budget planning in conjunction with the President’s Budget; and (3) annual evaluation planning for the use of the PHS one-percent evaluation set-aside authority.

First, HHS evaluation activities support the Department’s strategic planning and performance management activities in several ways. Completed evaluation studies are used in shaping the specific HHS strategic goals and objectives. Evaluation findings provide an important source of information or evidence about the success of various HHS programs or policies that collectively make up the strategies to achieve the goals and objectives. The HHS Strategic Plan highlights evaluations that document efficacy or effectiveness of strategic programs or policies and lists future evaluations that will benefit strategic planning. HHS agencies are also using findings from their evaluations to support GPRA annual performance reporting to Congress and program budget justifications.

Secondly, Congress requests that HHS coordinate all of its research, demonstration, and evaluation programs to ensure that the results of these projects address HHS program goals and objectives. ASPE and the Assistant Secretary for Management and Budget work together with HHS agencies to provide the Congress with a special annual research, demonstration, and evaluation budget plan that coincides with the preparation of the President’s fiscal year budget. The plan outlines HHS agency research, demonstration, and evaluation priorities as related to the Department’s strategic goals and objectives.

Thirdly, those agencies and offices that use the PHS one-percent evaluation set-aside authority—AHRQ, CDC, HRSA, NIH, ASPE, OPHS, SAMHSA—submit a formal plan to ASPE, which coordinates and develops the individual plans into the HHS report to the Congress on the use of the PHS one-percent authority. This report must be submitted to the Congress before HHS can implement the plan.

Project Management

The design and management of evaluation projects at HHS is principally decentralizedthe HHS agencies, OIG, and ASPE all are responsible for executing annual evaluation plans, developing evaluation contracts, and disseminating and applying evaluation results. Even within agencies while there is some oversight responsibility and execution capability in the Office of the Director or Administratorthe various subunits (centers, institutes, and bureaus) conduct much of the day-to- day evaluation activity.

The OIG performs independent evaluations through its Office of Evaluations and Inspections (OEI). The OEI’s mission is to improve HHS programs by conducting inspections that provide timely, useful, and reliable information and advice to decision makers. This information (findings of deficiencies or vulnerabilities and recommendations for corrective action) is usually disseminated through inspection reports issued by the Inspector General. A summary of individual inspection reports and other OIG reports can be viewed on the Internet at http://www.hhs.gov/oig/oei. OEI also provides technical assistance to HHS agencies in conducting their evaluations.

Quality Assurance and Improvement

Most evaluation projects are developed at the program level. The initial quality review is generally conducted by a committee of agency- or office-level policy and planning staff members. Before a project is approved, however, it is also reviewed for technical quality by a second committee with expertise in evaluation methodology. Technical review committees follow a set of criteria for quality evaluation practice established by each agency. Some HHS agencies also have external evaluation review committees composed of evaluation researchers and policy experts from universities and research centers.

Since HHS began reporting to Congress in 1995 on evaluations completed and in-progress through the Performance Improvement report series, the Department has focused more attention on the improving the quality of evaluation studies performed every year. The Evaluation Review Panel, convened yearly to recommend evaluations for highlighting in Chapter II of this report, has contributed insights to HHS evaluation officers on the strengths and challenges of ensuring quality evaluation studies. HHS evaluation officers have had opportunities to discuss these strengths and challenges with the Panel and to identify steps to improve agency evaluation capacity.

Based on these discussions, ASPE initiated two evaluation capacity-building projects in

FY 2000: a department-wide evaluation training needs assessment survey and establishment of an evaluation consultant contract mechanism to assist agency program managers.

Dissemination of Evaluation Reports

Maintaining report libraries and distributing information on evaluation results is an important component of HHS evaluation management. The Departments information and reports on major evaluations is available centrally through the website of the HHS Policy Information Center (PIC). The website address is: http://aspe.hhs.gov/PIC/ The PIC website offers users an opportunity to search (by key word searching or by selected program or policy topics) the departmental evaluation data base and electronic report library maintained by ASPE. As an information data base and library resource, the PIC contains nearly 7,000 completed and in-progress evaluation and policy research studies conducted by the Department, as well as key studies completed outside of HHS by the U.S. General Accounting Office (GAO) and private foundations.

Typically, the results of HHS evaluations are disseminated through targeted distribution of final reports, articles in refereed journals, and presentations at professional meetings and conferences. Although individual HHS agencies have primary responsibility for disseminating results, the ASPE will continue to its Department-wide efforts to expand dissemination of evaluation results to the larger research and practice communities through centralized computer communications and publications like the PIC website and database.

1 - FDA programs are principally authorized by legislation other than the PHS Act, specifically the authority of the Agriculture, Rural Development, Food and Drug Administration and Related Agencies Appropriations Act. IHS programs are authorized under the Indian Health Care Improvement Act and the Indian Self-Determination Act, and appropriated under the Department of the Interior and Related Agencies Appropriations.

Chapter II. Highlights of Outstanding Evaluations Completed During Fiscal Year 1999

In this chapter, the U.S. Department of Health and Human Services (HHS) highlights evaluations of general interest to the public health, health care services, and human services community, and illustrates the diversity of HHS evaluations completed in fiscal year (FY) 1999. Included are summaries of six evaluation projects selected by the HHS Evaluation Review Panel, a group of outside evaluation experts. The Panel reviewed 26 reports nominated by HHS agencies and selected the reports to be highlighted in this chapter on the basis of the following criteria:

  • Is the report important? Does it address a significant issue or problem for which evaluation would confirm or change program direction, or measure program impact? Are the findings likely to be useful and generalizable?
  • Is the report methodologically sound? Are its concepts, designs, data collection, and analyses conducted and reported in a competent manner?
  • Is the report faithful to the data? Do the conclusions and recommendations logically follow from the data and analyses, and are they relevant to the questions asked?

These criteria are more fully described in the Appendix.

The six studies are organized under two headings: program effectiveness evaluations and environmental assessments. These headings represent two common uses of HHS evaluation resources. Program effectiveness evaluation provides a way to determine the impact of the Departments programs on achieving intended goals and objectives. Environmental assessment is the way we understand the forces of change in the health and human services environment that will influence the success of our programs and the achievement of our goals and objectives.

Program Effectiveness

Case Studies of the PMI Local Demonstration Site Projects: Experiences During Transition and Implementation

Highlights

Young people under 26 may be at risk for HIV and other sexually transmitted diseases and need information on how to prevent it. The Prevention Marketing Initiative (PMI) was a 5-year demonstration of social marketing initiated by the Office of HIV/AIDS of the Centers for Disease Control and Prevention in 1993. Prevention marketing involves social marketing, the behavioral sciences, and community participation. Both local and national in scope, PMI has three major components: local demonstration sites, national health communications, and prevention collaborative partners such as health communication firms.

This study evaluates the implementation phase of local demonstration projects in five sites. During the five years of the project, researchers conducted two case studies involving prevention marketing HIV/STD programs for young people under the age of 26. The first, completed in 1996, reported on the interventions designed by the local sites. The second describes the experiences of the local sites and the collaborative national partners who provided technical assistance during the transition and implementation phases of the project.

Purpose

The purpose of the PMI demonstrations was to test the efficacy of combining social marketing with elements of behavioral sciences and community participation in reducing the risk of AIDS in young people. The researchers applied the concept of prevention marketing to the demonstration sites as an experiment in demonstrating the prevention marketing process, including the skills and resources needed to engage the community effectively; measuring the behavioral effects of data-based prevention marketing interventions; and documenting the lessons learned that may inform future prevention-marketing efforts. In addition to describing the experiences of the project participants, information in the second case study also will provide context for further evaluation of both outcomes of site-based skills-building workshops and the community-wide level of exposure to media messages.

Background

During the planning of the project, each site considered intervention components previously shown as effective, with each site tailoring intervention components to its target audience and prevention objectives. Sites chose multifaceted interventions using social marketing techniques to reach the targeted population delivered through workshops and outreach components. An initial task was to hire staff and build community participation among key organizations and individuals. One national partner, the Academy for Educational Development (AED), and its partner, Porter/Novell, provided intensive technical assistance, focusing on developing organizational structures, establishing procedures for managing potential resistance to prevention programs, and building community participation.

In the following year, demonstration sites received technical assistance in conducting formative research, considered a critical step in social marketing. It involves an assessment of local needs and resources, helping to define target audiences and behavioral objectives through focus groups and other research, such as community environment and epidemiological profiles. Some sites added development of community networks or the support of community leaders to their plans.

Local sites chose interventions to reduce levels of selected risk behaviors among their target audiences, adapt programs to their local needs, and plan for implementation during the next two years. AED continued to provide technical and managerial support through the end of the fifth year. In the final year of the project, sites focused on fielding their efforts, evaluating them, and planning for continuity of their efforts.

Methods

This study had two major objectives: to describe changes in organizational structures and processes that had occurred since the first case study was conducted in 1996, and to document experiences with the major components of PMI during its final two years. The components involved social marketing, community collaboration (including media relations), behavioral science, youth participation, and technical assistance. Collecting and analyzing qualitative data was guided by seven research questions designed to meet the major objectives.

The case study used a qualitative approach to capture the experiences and recommendations of the PMI participants. A two-person field team visited each site and conducted interviews with 64 people. They conducted 10 more interviews with the national partners. The team used these sources of information to evaluate the project: (1) interviews with PMI staff, volunteers, and implementation partners; (2) observations of meetings or activities that occurred during the data collection period; (3) interviews with such national partners as technical assistance providers and project officers; (4) a review of current site-based documents; and (5) the final report for the initial case study. The data collected and analyzed then were used to create a thematic database, case summaries, and the final report representing an integrated summary of findings across all sites.

Findings

All five PMI sites contained structural elements that remained the same throughout the project. These included a lead agency, an advisory committee, an on-site staff, a youth committee, and technical-assistance providers. The sites experienced high turnover in organizations and individuals as the PMI project moved from planning to implementation. The lead agency changed at all five sites because of a mismatch of PMI site objectives and those of the lead agencies. The sites selected new agencies to manage implementation of the interventions. The role of the advisory committees changed from planning to project oversight; however, several sites experienced declining attendance and interest when they failed to define a clear role for their advisory committees.

A significant change in the program plan was to engage subcontractors to field the intervention components and evaluate the interventions. One aspect of the intervention implementation seen by respondents as highly successful was the way the various components of programs worked together and complemented each other.

Several forms of evaluation were used to document the effects of PMI, including: (1) community- based telephone interview in Sacramento assessing the scope and effects of the program; (2) a workshop evaluation to assess the effectiveness of the program for participants 3) process evaluation including this case study; (4) monitoring and accountability, and (5) formal and informal evaluations conducted by the sites themselves.

The community-based outcomes study involved a random telephone survey of teenagers inquiring about their attitudes, knowledge gains, and sexual behavior as a result of the PMI project. Sacramento provided convincing evidence that exposure to the social-marketing campaign produced the desired results–increased condom use among sexually active teenagers. More than 60 percent of the teens in the Sacramento target area were exposed to the social-marketing campaign through multiple channels.

Use of Results

The Prevention Marketing Initiative is a model that may be replicated and modified to fit the needs of other communities. The final report lists numerous recommendations based on the findings of the case study and lessons learned from the experiences of the project participants that will be of value to future public health promotion efforts.

AGENCY SPONSOR: Centers for Disease Control and Prevention

FEDERAL CONTACT: Nancy Chalmers

PHONE NUMBER: 404-639-7085

PERFORMER ORGANIZATION: Battelle, Durham, NC

The Impact of Health Claims on Consumer Search and Product Evaluation Outcomes: Results from FDA Experimental Data

Highlights

The relationship between the regulation of health claims on food labels and the actual effects on consumer behavior in searching for and using the information provided is the subject of this study. The researchers interviewed more than 1,400 shoppers to assess and record how consumers use food label information appearing in different areas of the label when evaluating a product and making a purchase decision. The results suggested that consumers are likely to read no further than the health and nutrient-content claims on the front of the package and to give greater weight to the information mentioned in them than that contained in the Nutrition Facts panel.

Health claims also were found to produce a halo effect, extending to other health aspects not mentioned in the claim, and, in the case of one of three food products tested, a magic-bullet effect, attributing inappropriate health benefits to the product. The study acknowledges and extends earlier research and discussion of consumer information search behavior and regulation of health claims on food labels by the Food and Drug Administration.

Purpose

The authors wanted to better understand the extent of consumer reliance on health claims appearing on the front of food packages and their extended search to the back of the package to view the Nutrition Facts panel. The study sought to answer this question: “Do consumers rely only on claims when evaluating a product and making a purchase decision, and if so, how does this affect their nutritional judgments and the quality of their choices?”

Background

The 1990 Nutrition Labeling and Education Act (NLEA) regulates health claims on food labels. NLEA was enacted to “assist consumers in maintaining healthy dietary practices” amid concerns that unregulated health claims might be confusing and deceptive.

Health claims first appeared on Kellogg products in 1984. The number and types of diet and disease linkages used in advertising and on food labels throughout the early 1990s rapidly increased following Kellogg’s initiative. Research indicated that health claims and product advertising since 1984 have increased consumer awareness of diet-disease linkages and given rise to new or reformulated food products with greater nutritional value. Some, however, believed that health claims and product advertising were incomplete or misleading and failed to provide accurate information to consumers about the nutritional content of the product.

The Food and Drug Administration issued implementing rules for NLEA in May 1994, limiting claims to those supported by “publicly available scientific evidence” and the types of products that display health claims to those that meet a set of global nutritional standards. New products following enactment of NLEA tended to be healthier by reducing the level of negative nutrients, such as fat. However, researchers have found it difficult to measure the effects of health claim regulations, given the NLEA requirement that the Nutrition Facts panel appear on food labels. As early as 1973, numerous studies have been conducted using experimental protocols to understand the effects of nutrition information on consumer behavior.

Methods

A total of 1,403 primary food shoppers were interviewed at eight United States metropolitan statistical areas located in the Northeast, Southeast, Midwest, and Southwest. Interviews were conducted with each subject following initial screening on the basis of the relative amount of shopping, age, literacy, and

ability to read small print. Participants were presented three-dimensional mock-ups of well-known products (with brand names removed) under three categories of products, cereals, lasagna, and yogurt. The researchers experimentally manipulated an independent variable, creating ten variations in label conditions. Participants were given time to examine the package of each product prior to being asked a set of prescribed questions. In each question series, the researcher observed whether the respondent looked at (a) only the front panel of the package, (b) only the Nutrition Facts panel, (c) both the front and the Nutrition Facts panels; or (d) neither panel. The researchers tested ten separate outcome predictions relating to the effects of the truncated information search and the presence of health or nutrient-content claims on consumer information search and processing behavior.

Findings

The results of inferential statistical tests suggested that the presence of a health claim and a nutrient claim on a food package has a significant effect on the relative degree to which consumers limit their search for nutrition facts to the front panel of food packages. Consumers who either truncate their information search to the front or view nutrient claims are significantly more positive in their summary judgments of products. These consumers also are more prone to give greater weight to the information cited in the health claims than to that presented in the Nutrition Facts panel.

Information search behavior affected product ratings and health evaluations, independently from the presence of a health claim. For example, those who look only at the front panel give significantly higher purchase intention ratings than those who consult the Nutrition Facts panel. Researchers discovered this effect to be as large as those associated with product type or education level. They also found that the presence of a claim on a food package significantly influenced the halo effect described earlier, and for one product tested, a magic-bullet effect.

Use of Results

The findings of the study are useful and of interest to several audiences. For the FDA, the findings support the rationale for regulation of health claims. Based on the data, the authors suggest that manufacturers may find it “advantageous to rely more heavily on” nutrient-content claims, because the regulations permit a greater number of products to qualify for nutrient-content than for health claims. The effect of the latter on consumer information search and evaluation were found to be similar to that of health claims. Findings from the study may increase public awareness and encourage consumers to read beyond health claims. It extends previous research efforts and also suggests further avenues for explanation of consumer search and product evaluation behavior.

AGENCY SPONSOR: Food and Drug Administration

FEDERAL CONTACT: Alan Levy

PHONE NUMBER: 202-205-9448

PERFORMER ORGANIZATION: Food and Drug Administration, Rockville, MD

The Costs and Benefits of Substance Abuse Treatment: Findings from the National Treatment Improvement Evaluation Study (NTIES)

Highlights

This study investigated the costs and benefits that accrue as the result of substance abuse treatment. Using data from NTIES, the research team constructed and compared estimates of treatment costs, crime-related and health care costs, and the income of 5,264 substance abusers in the periods before and after treatment. The findings of the study indicate dramatic reductions in crime-related costs, modest reductions in health-care costs, and modest increases in the earnings of substance abusers in the period after treatment.

Purpose

Despite federal expenditure of over $2 million and an overall national expenditure in excess of $12 billion, it is estimated that about 1 million substance abusers in need of publicly supported treatment do not receive services. Policymakers often face the difficult task of justifying to taxpayers the use of public funds to support substance abuse treatment. For the public and policymakers, the relevant question relates to the degree to which substance abuse treatment provides benefits for the rest of society. Thus, the economic soundness of relevant policies depends on the cost effectiveness of treatment. The primary purpose of this study was to assess the costs and benefits of alcohol and drug abuse treatment and determine the resulting economic benefits to society.

Background

One of the major goals of the DHHS Center for Substance Abuse Treatment (CSAT) is to improve the lives of those affected by alcohol and other substance abuse, and through treatment, to reduce the adverse effects of substance abuse on individuals, families, communities, and the society at large. Toward this goal, CSAT has invested and continues to invest significant resources in the development and provision of effective substance abuse treatment and recovery services. In 1996, Federal expenditure accounted for almost $2.7 billion of the about $12.7 billion national expenditures for the diagnosis and treatment of alcohol and drug abuse. Issues related to the investment in or continuation of existing programs and the development of new programs generally center on their efficacy and the extent to which they are cost effective. The collection and systemic analysis of high-quality data about substance abuse treatment services, clients, and outcomes provide sound scientific evidence upon which to address such questions as which treatment approaches are cost-effective methods for curbing addiction and addiction-related behaviors and what kinds of treatment work for what groups of clients. The National Evaluation Data Services (NEDS) project was established to provide CSAT with data management and scientific support services across an array of programmatic and evaluation activities. One of the specific objectives of the NEDS project is to provide CSAT with the capability to use existing data to address policy-relevant questions about substance abuse treatment. The investigation of the costs and benefits of alcohol and drug abuse treatment and the economic benefits to society was undertaken in pursuit of this objective.

Method

The research task for this study was accomplished by analyzing NTIES “client-level” data and service delivery (SDU) administrative data collected between FY1992 and FY1995 on 5,264 clients who were in treatment demonstration programs supported by CSAT. Using SDU’s administrative/ service data, the research team constructed estimates of treatment costs per client for each of the modalities and across all modalities. To measure benefits, the research team estimated and compared the average costs per client, in terms of crime-related and health-care cost associated with substance abusers, and the income and social welfare benefits received by substance abusers in the 12 months prior to and after treatment. The difference between pre-treatment and post-treatment costs was used to estimate the economic impact of substance abuse treatment.

Findings

The analysis of data revealed: 1) approximately 75 percent reductions in crime-related costs; 2) 11 percent reduction in health-care costs per client; and 3) 9 percent increase in the earnings of substance abusers in the period after treatment. No change was found in welfare payments and Supplemental Social Security Income. Overall, the results obtained indicate that treatment created an average benefit to society of $9,177 per client and an average benefit to the non-treated population of $12,477 per client. Deducting the cost of treatment per client resulted in average treatment benefits of $6,236 and $9,536 per client for society and the non-treated population, respectively.

The research team concluded that, based on these results, the total benefits of substance abuse treatment, in terms of avoided costs and increased earning, far exceeded the costs of treatment. As a recommendation, the researchers indicated that the next steps should include analyses to identify what kinds of treatment works for whom. The team intends, in future work, to link intensity and cost of services to outcomes to identify the cost effectiveness of different treatment services.

Use of Results

Because of the large numbers of incomplete responses to cost questions in the baseline and administrative survey questionnaires, and discrepancies between total revenues and sum of details reported by SDU's the researchers choose to proxy treatment costs with information on revenues. Nevertheless, there is no evident reason to believe that the outcomes of the study would be any different, especially in light of the special steps the researchers took to ensure the reliability of the information derived.

AGENCY SPONSOR: Substance Abuse and Mental Health Services Administration

FEDERAL CONTACT: Ron Smith

PHONE NUMBER: 301-443-7730

PERFORMER ORGANIZATION: Caliber Associates, Fairfax, VA

Environmental Assessments

Analysis of Prescription Drug to Over-the-Counter (Rx-to-OTC) Switch Movement

Highlights

This study identified the trend and some possible reasons for the Rx-to-OTC switch movement; estimated the price and income elasticities of OTC switch drugs; and described the relationship between the demand for OTCs and select market and demographic variables. The study also examined the impact of specific Rx-to-OTC switches on clinical practice patterns, costs and benefits associated with the OTC switch movement, and the levels and types of Medicaid coverage for OTCs in different states. To conduct the study, the researchers reviewed the literature, and conducted key informant group interviews and analyzed select data sets. The findings of the literature review indicated that a number of forces have had an impact on the Rx-to-OTC movement: the market expansion motives of pharmaceutical companies, the trend toward deregulation. the individual autonomy/self-help movement, and health care containment efforts. Key informant interviews revealed that the switch trend was viewed as a positive one. Other analysis revealed a general increase in the demand for OTCs; higher benefits associated with the OTC switch relative to costs, and different types and levels of coverage of OTCs in Medicare Plans, from state to state. The study enabled the researchers to identify a set of questions requiring research attention.

Purpose

This study focused on the impact of “switched drugs” and the switch trend–that is, prescription drugs (Rx) which have been switched to over-the-counter (OTC) status, with emphasis on more recent switches and potential switches. The central aim of the study was to provide a comprehensive review and analysis of the Rx-to-OTC switch movement in order to inform policymakers and define relevant research questions.

Background

Approximately 600 over-the-counter (OTC) products currently available use ingredients and dosages available only by prescription 20 years ago. While there has been a steady stream of OTC switches since the mid-1970s, the number of switches has accelerated in recent years. Between 1988 and 1994, there were 14 switches, while in the last three years thee were at least 19 switches. Some of the possible reasons cited for this trend include: 1) a growing emphasis on individual autonomy and self-help; 2) a trend toward deregulation in the U.S.; 3) health care cost containment efforts; and 4) pharmaceutical industry self-interest/profit. The issue of Rx-to-OTC switching deserves considerable attention because of the large number of people who could be affected by the trend, including consumers, pharmaceutical companies, physicians, pharmacists, and payers.

Methods

The project began with a review of the literature related to the Rx-to-OTC switch movement. Based on the results of the literature review and discussions with the Research Advisory Group, an interview guide was constructed and administered to seven key informants representing pharmacists, consumers, policymakers, physicians, pharmaceutical companies, and payers. The interview guide covered three areas related to the switch movement: understanding the trend, understanding the process for switching drugs, and policy issues. Sales data for three recent switch drugs (H2 blockers, vaginal anticandidals, nicotine replacement products) were analyzed to examine the impact of specific Rx-to-OTC switches on clinical practice patterns. Focusing on the OTC availability of vaginal anticandidals, the research team identified and compared the benefits and potential negative outcomes associated with the OTC switch, taking into account the likelihood of their occurrence. In addition, the team examined epidemiological and medical literature to ascertain what researchers do or do not know about occurrence and treatment of vaginitis. Using data on state Medicaid plan coverage, the researchers examined the levels and types of OTC coverage provided in different states, and compared the utilization of “alternative” prescriptions and overall costs per beneficiary for plans that do and do not cover specific OTCs.

Findings

The literature review identified the market expansion motive on the part of pharmaceutical companies; the individual autonomy/self-help movement; the trend toward deregulation in the U.S.; and health care cost containment efforts as four major forces responsible for the Rx-to-OTC switch movement. In general, key informant interviews revealed that: 1) the switch trend was viewed as a positive one, providing increased access to safe and effective drugs and cost savings, primarily through reduced office visits and work time lost; 2) the FDA process for reviewing potential switches was seen as adequate and the number and types of switches as appropriate; 3) drug safety and efficiency profiles as well as the ability of individuals to appropriately self-diagnose and self-medicate were seen as the critical elements in the timing of an OTC switch; 4) the best types and levels of OTC information and the translation of that information into consumer knowledge of appropriate OTC use wee cited as critical policy issues; and 5) insurance coverage of OTCs was not seen as an issue of significant policy concern at this time.

Analysis of the demand for OTC switch drugs (H2 blockers, nicotine replacement medications, vaginal anticandidals) revealed that: 1) the demand for H2 blockers and vaginal anticandidals was relatively elastic (i.e., sensitive to price), but the demand for nicotine replacement medications was relatively insensitive to price; 2) increases in income led consumers to purchase more of the OTC products; 3) lower income populations were more to OTCs; 4) OTCs may actually serve as a substitute for conventional medical care (physician and hospital care). Results of estimations of individual demand for specific OTC brands within the three categories were generally consistent with the researchers expectations that these OTC markets are characterized by monopolistic competition.

The results of the analysis of the impact of OTC switch drugs indicate that: 1) the average number of vaginitis visits per woman decreased significantly in the post switch period (1990-1994); 2) the OTC switch of the more potent version of hydrocortisone (1%) had little impact if any on the number of patients seeking physician care for dermatitis complaints; 3) prescription rates for clotrimazole and miconazole decreased significantly after these medication switches to OTC, but there did not appear to be a significant increase in the prescription rates for other “substitute medications,” 4) prescription rates for hydrocortisone fell after the medication went OTC; and 5) the only related dermatitis drugs that were prescribed significantly more in 1990 and 1985 were those used for the treatment of acne. The study revealed that the estimated benefits of OTC anticandidal availability per person ($61.96) outweighed the estimated costs ($3.85).

With regard to trends in Medicaid coverage of OTCs, the study revealed that: 1) the number of OTCs covered varied significantly (from 0 to 408) from state to state; 2) the average level of (Medicaid) OTC expenditures per state in 1997 was $296 million; 3) OTC expenditures represented approximately three percent of Medicaid pharmaceutical budgets; 4) in general, Medicaid cost per beneficiary for OTC substitute drugs did not appear to differ significantly between states that do or do not cover OTC vaginal anticandidals; and 5) Medicaid OTC costs rose 38 percent between 1994 and 1997, and increased slightly less than the increase in pharmaceutical costs per beneficiary (48%) over the same period.

Use of Results

Consistent with the exploratory nature of this study and the expectations of the researchers, the study generated several questions, such as: How do consumers make decisions to purchase OTCs versus seeking professional care? How do clinicians treat patients in the presence of OTC products and lack of insurance coverage? What is the impact of health outcomes? Is it cost effective for health care plans to cover OTCs? How will decision-making change as more products become OTC? These questions and others raised in the study and the gaps in our knowledge of anticandidals self-medication are some of the areas that must be addressed with further research.

AGENCY SPONSOR: Office of the Secretary, Office of the Assistant Secretary for Planning and Evaluation

FEDERAL CONTACT: Laina Bush

PHONE NUMBER: 202-260-7329

PERFORMER ORGANIZATION: Northwestern University, Evanston, IL

Results of a Multi-Site Study of Mandatory Medicaid Managed Care Enrollment Systems: Implications for Policy and Practice

Highlights

Under most Medicaid managed care plans, beneficiaries who do not select a plan are automatically assigned to one. In some states, as many as 60 to 75 percent of these people may have been automatically enrolled. Concerns about this high rate of automatic assignment and whether the enrollees were making an informed choice prompted this study, which describes the effects of enrollment and autoenrollment (automatic assignment) policies and practices under mandatory Medicaid managed care on federally qualified health centers (FQHCs), FQHC networks and their plans, and their patients.

This study, the second phase of a two-part research project, examined the enrollment policies and practices under mandatory Medicaid managed care (MMMC) in nine states, and the experiences of Medicaid beneficiaries enrolling in managed care. Researchers also assessed the effects of MMMC enrollment policies on federally qualified health centers (FQHCs) and their ability to survive managed care. The first phase of the study grew out of the desire to gain greater understanding of possible causes for the high rates of auto-enrollment (mandatory assignment to a health plan when beneficiaries do not voluntarily enroll) in state Medicaid managed care programs. Because Medicaid managed care enrollment is one of the least well understood aspects of managed care, researchers wanted to improve the level of understanding about emerging issues and identify implications for access and quality.

Purpose

The number of Medicaid beneficiaries enrolled in mandatory managed care programs has grown rapidly since 1990, creating a need to learn more about the dynamics of all facets of managed care. There is an evident need to develop a better understanding of how various state enrollment policies are constructed, how the enrollment practices actually work, and the significance of these policies and practices for beneficiaries, plans, and providers.

Background

Concerned about the high rates of automatic enrollment in Medicaid plans, researchers reviewed policies and practices in 34 states with MMMC programs and found that they varied greatly, with no discernible association between particular state autoenrollment policies and high levels of autoenrollment. Medicaid beneficiaries have little or no knowledge about managed care and state agencies have limited knowledge and experience with managed care delivery systems and are also hampered by budget constraints. How people are enrolled in Medicaid has important implications for them, including access to and continuity of care, the stability of their existing relationships with providers, and their overall satisfaction with managed care. Mandatory enrollment also affects healthcare providers and may help determine the structure of the managed care market. The way States approach mandatory enrollment may influence market entry by various types of managed care plans as well as their stability and survival.

Methods

The methodology for the project involved a series of case studies conducted in nine states. Researchers analyzed numerous descriptive variables when selecting states from which to draw the case studies among the 34 with significant Medicaid managed care activity. The variables included autoenrollment rates, use of enrollment brokers, how long MMMC had been implemented, and FQHC’s experience with changes in patient volume and revenue. The researchers used focus groups to gain a picture of the enrollment experiences of Medicaid beneficiaries under their states’ Medicaid managed care programs. They also examined the experiences of providers which traditionally serve beneficiaries, particularly federally qualified health centers, because they are especially challenged by MMMC. The team constructed five study questions with subquestions to address the study objectives and to identify major areas of inquiry for the research. It also conducted structured interviews onsite with state Medicaid officials, managed care plan officials, FQHC representatives, Medicaid beneficiaries, and community advocates.

Findings

Seven major findings emerged from this study:

  1. States shared many enrollment practices in common, but varied in their commitment and approach to outreach and education among patients about enrolling in managed care. Intensive use of community-based organizations (CBOs) emerged as an increasingly successful strategy for meaningful outreach and education.
  2. Lack of information about providers and plan networks consistently precluded Medicaid beneficiaries from exercising a choice during enrollment. This fundamental inability to choose has the potential to undermine the Federally Qualified Health Centers (FQHCs’) strategies to retain patients and gain new ones.
  3. Managed care plans primarily were concerned about unstable markets due to unstable eligibility/enrollment patterns for beneficiaries and declining Medicaid caseloads.
  4. For FQHCs, enrollment concerns were important but secondary to reimbursement problems in terms of the compelling challenges associated with surviving managed care.
  5. Medicaid beneficiaries reported that the ability to choose their provider was most important and that access to information necessary for choice was limited. Their most valued and effective sources for such information were their providers and CBOs.
  6. Enrollment plays two critical, and potentially conflicting, roles in mandatory Medicaid managed care (MMMC): ensuring that beneficiaries get coverage by entering a plan, and creating a market by making large groups of people available to plans. Autoenrollment was of uncertain and variable importance.
  7. Market pressures on state officials to ensure rapid implementation of MMMC programs resulted in enrollment procedures and practices that did not give beneficiaries the information necessary to choose their providers and to navigate managed care.

Use of Results

Potential uses of the findings are to: Improve the quality of information on plans and providers given to beneficiaries to help them voluntarily choose a plan; Develop strategies for improving the enrollment process; Identify common interests among the states, managed care plans, FQHCs, and beneficiaries; Generate collaborative problem solving between public and private policymakers.

AGENCY SPONSOR: Health Resources Services Administration

FEDERAL CONTACT: Dana Jones

PHONE NUMBER: 301-594-4058

PERFORMER ORGANIZATION: George Washington University, Washington, DC

Drug Use Prevalence Estimates Among Adult Arrestees in California, Texas, and the U.S.: Final Report

Highlights

If drug abuse among criminal offenders is to be successfully tackled as a vital issue on the national agenda, policymakers need the best available data. In an effort to provide better estimates of national drug use among arrestees, the researchers in this study discovered that multiple capture rates (the rates at which individuals appear in repeated arrests on a database or are “rearrested”) were significantly higher than those reported in earlier literature on the subject. In this study, the investigators estimated drug use prevalence for various sizes of arrestee populations using state and national samples; evaluated the applicability to large-scale data sets, as well as to various subgroups, of a previously developed regression model for synthetic estimation; examined the predictive power, sensitivity, and robustness of the model; and conducted testing to increase the accuracy of model estimates. The overall aim of the research was to obtain better estimates of drug use prevalence to lend greater scientific support to policy decisions and allocations of resources. The researchers applied the direct projection, bootstrap, and logistic regression synthetic estimation techniques using the national Drug Use Forecasting (DUF) project data, California DUF-like survey data, national FBI Uniform Crime Report (UCR) data, the California Monthly Arrest and Citation Register (MACR) data, and the 1990 U.S. Census and 1996 Current Population survey information to produce scientifically defensible estimates of drug use prevalence among arrestees. For example, the study indicates that of the 1.17 million adults arrested in California in 1996, more than a fourth were arrested for drug-related offenses, and 65 percent had used drugs before their arrest.

Purpose

Policymakers need reliable information about drug use among criminal justice populations to more effectively respond to problems associated with drug use and crime. The need for improved drug use prevalence estimation techniques has been emphasized by several government agencies. The previous work of researchers from the UCLA Drug Abuse Research Center (DARC), including an initial study of regression modeling for drug use prevalence estimation, resulted in the development of a regression approach to synthetic estimation of drug use prevalence. This comparative follow-on study was conducted to: 1) estimate drug use prevalence for various sizes of arrestee populations using data from three separate studies of California, Texas, and national samples; 2) evaluate the applicability of the previously developed regression model for synthetic estimation to large-scale data at local, state, and national levels, as well as to various subgroups defined by gender, race/ethnicity, age, and type of offense; 3) examine the predictive power, sensitivity, and robustness of the regression model for synthetic estimation; and 4) determine overall and subgroup multiple capture rates (repeated arrests) to increase the accuracy of model estimates.

Background

The high number of drug users in the criminal justice population and the immense costs and consequences of drug-related activities to society have been central topics of recent policy discussions. Studies have shown that the prevalence of drug use among arrestees is far greater than expected on the basis of estimates derived from general population studies. Policymakers have emphasized the need to obtain better estimates of drug use prevalence to scientifically support policy decisions and allocation of resources. Without enumeration of actual drug use among criminal justice populations, policymakers must base their decisions on reliable estimates obtained from comprehensive approaches which compensate for incomplete information and encompass various drug-related phenomena. Typical applications of the synthetic estimation methods have been limited by the lack of consistent empirical evidence of relationships between drug use prevalence and the indicators selected as covariates for model inclusion. To improve prevalence estimation methods, the UCLA Drug Abuse Research Center (DARC) conducted an initial study of regression modeling to estimate drug use prevalence among arrestees, resulting in improved conceptualization and preliminary application of a regression model. This study is part of an ongoing effort to evaluate the applicability of the flexible regression model to small-scale, relatively large-scale, and large-scale data.

Method

The project performed secondary analysis on data from five major sources: the national DUF (ADAM) project, the California DUF-like survey data, the national Uniform Crime Report (UCR) data provided by the FBI, the California Monthly Arrest and Citation Register (MACR) data, and the 1990 U.S. Census and 1996 Current Population Survey information. The national and California DUF data served as the calibrator to estimate the number of drug users among arrestees in the national and California MACR data. Prevalence estimation at the county, state, and national levels were generated in three relatively independent studies for California, Texas, and the nation. To yield prevalence estimates, the research team used a three-step logistic regression model and estimation procedure. First, they conducted a separate logistic regression analysis using DUF data as the calibrator for each of the 96 subgroups defined by gender, race/ethnicity, age, and crime type. Second, they used the regression coefficients estimated from the logistic regression to derive drug use rates at county, state, and national levels. Finally, they obtained estimates of the number of drug-using arrestees in all subgroups at county, state, or national levels by multiplying derived prevalence rates by the number of arrestees in county, state, or national arrestee populations. For comparison purposes, they used two other methods in addition to logistic regression: 1) Direct projection of drug use rates from DUF survey data to calculate drug use prevalence in arrestee populations represented in state-wide or national arrest data; 2) The Bootstrap Method to estimate drug use rates and their standard errors from the DUF survey data to estimate drug use prevalence in larger arrestee populations.

Findings

A major finding of this study was that multiple capture rates (the rate at which individuals appear multiple times in the same database, or are “re-arrested”) were significantly higher than those reported in the literature. Moreover, multiple capture rates dramatically differed by gender, race/ethnicity, and crime type. The overall recapture rate among California arrestees in 1996 was about 30 percent. The overall recapture rates were highest for drug-related offenses. The study showed that 1.27 million adults were arrested 1.64 million times in California, in 1996. More than a quarter of the total number were arrested for drug-related offenses, and 65 percent had used drugs within three days of their booking date. Among the number of those arrested in California, about 770,000 were projected to be drug users. The study showed that 863,000 adult arrests were reported in Texas in 1996. Based on the regression analysis performed, the projections for adult arrestees and drug users was 13 percent higher than those produced by the bootstrap and direct projection methods. The analysis of national-level data revealed that in 20 of the 23 DUF sites, more than 60 percent of adult male arrestees in 1996 were positive for at least one drug; in 21 of 23 sites, more than 50 percent of female arrestees tested positive for at least one drug.

The study indicated that the regression model needs to be further expanded to include a wider range of drug abuse indicators and associated variables to stabilize estimations at various administrative levels and for special groups.

Use of Results

The study provided compelling evidence that regression models of synthetic estimation are sensitive to, and capable of, high-confidence estimates of drug use prevalence at local and state levels for many different subpopulations, as well as for the nation as a whole. The clear, detailed findings related to estimates of drug-using arrestees and estimates for gender, race/ethnicity, age, and crime-type subgroups are very likely to be useful to policymakers and researchers who want a comprehensive picture of the prevalence of drug use among adult arrestees.

AGENCY SPONSOR: The Substance Abuse and Mental Health Services Administration

FEDERAL CONTACT: Ron Smith

PHONE NUMBER: 301-443-7730

PERFORMER ORGANIZATION: Caliber Associates, Fairfax, VA

Chapter III. Compendium of HHS Agency FY 1999 Evaluations Completed and In Progress

The various agencies and offices of the Department of Health and Human Services (HHS) maintain their own evaluation program—including the functions of evaluation planning and policy review, quality assurance through technical review, project coordination and management, dissemination of reports, and utilization of results. This chapter is a compendium of the evaluations completed and in progress during fiscal year (FY) 1999, organized by the following HHS components:

  • Administration for Children and Families
  • Administration on Aging
  • Agency for Healthcare Research and Quality
  • Agency for Toxic Substances and Disease Registry
  • Centers for Disease Control and Prevention
  • Food and Drug Administration
  • Health Care Financing Administration
  • Health Resources and Services Administration
  • Indian Health Service
  • National Institutes of Health
  • Office of the Assistant Secretary for Planning and Evaluation
  • Office of Public Health and Science
  • Substance Abuse and Mental Health Services Administration

Each HHS agency and office section begins with an overview of the relevant evaluation program, describing its philosophy, policies, and procedures. Next are descriptions of the major evaluations completed in

FY 1999, grouped by major program areas. Lastly, the evaluations currently in progress are presented in chronological order of the expected date of completion.

For more information about a particular evaluation, either completed or in progress, the name and telephone number of the Federal contact person is included. Final reports for the completed

evaluations listed in this chapter are located at the HHS Policy Information Center (PIC), a centralized source of information on completed and in progress HHS evaluations. The PIC maintains a projects resource data base containing information on more than 6,000 studies sponsored by HHS, as well as other Federal agencies, and private-sector entities. The PIC identification number appears after the Federal contact's phone number. Access to the PIC resource database by the public is available through the following Internet address: <http://aspe.hhs.gov/PIC/>. For additional information about using the PIC resources, please contact the Policy Information Center at (202) 690-6445.

Administration for Children and Families

MISSION: To promote the economic and social well-being of families, children, individuals, and communities.

Evaluation Program

The Administration for Children and Families (ACF) administers a broad range of entitlement and discretionary programs, including income maintenance (Temporary Assistance for Needy Families [TANF]); child support; children and family services (Head Start, Child Welfare, Family Preservation and Support, and youth programs); four block grants; and special programs for targeted populations, such as the developmentally disabled, immigrants, and Native Americans.

The objectives of ACF's evaluations are to furnish information on designing and operating effective programs; to test new service delivery approaches capitalizing on the success of completed demonstrations; to apply evaluation data to policy development, legislative planning, budget decisions, program management, and strategic planning and performance measures development; and to disseminate findings of completed studies and promote application of results by State and local governments.

ACF actively engages with other Federal agencies, State and local policy and program officials, national organizations, foundations, professional groups and practitioners, and consumers to stay current on emerging issues affecting its programs and to identify questions for evaluation studies. Systems changes and how they affect vulnerable populations, particularly children, are of primary concern. The movement toward devolving responsibility for health and human services to State and local organizations—in particular, the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996—offer both tremendous opportunities and unprecedented challenges in redefining and implementing services for families.

Evaluation study designs are negotiated carefully with the States and other interest groups. Studies often are funded as joint ventures with the Office of the Assistant Secretary for Planning and Evaluation and other Federal agencies and foundations. Such collaborations permit large-scale efforts that are better informed and more representative of varying perspectives. Proposals are reviewed by multidisciplinary experts. Work groups of various kinds are used to monitor the progress of projects and to advise on design refinements and the presentation of findings.

Fiscal Year 1999 Evaluation Reports

Child Care

Sustaining Employment Among Low-Income Parents

This project developed optional research designs to identify and address the effects of child care costs on the employment of low-income parents, and the ways in which child care subsidy policies support employment by making child care more affordable and expanding child care choices. The major work in this contract consisted of a series of three stand-alone working papers and a final report that provide background for developing a research agenda that would inform the design of child care policy oriented toward families leaving welfare for work and toward low-income working families in general. The final report summarizes what we know about the cost of child care and its relationship to the employment and child care choices of low-income parents and proposes an agenda for future research. Two companion papers review research on the links between employment and the quality of child care and the issue of flexibility in family situations, jobs, and child care as it relates to the ability of parents to find a job and remain employed. The final report recommends a repeat of the Profile of Child Care Settings (PCCS) and the National Child Care Survey (NCCS) studies which would support further research on the effects of regulations and subsidy policies on the supply of child care. The studies should include subsamples of low-income parents, a sample of unregulated, home-based providers in at least a subset of sites, and an observational assessment of the quality of a subset of child care providers that could offer a nationally-representative measure of the quality of child care in the U.S.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Jakopic, Richard
202-205-5930

PIC ID: 6846

PERFORMER: Urban Institute/Mathematica Policy Research
Washington, DC

Family Services

Family Preservation and Family Support (FP/FS) Services Implementation Study

The 1993 Family Preservation and Family Support (FP/FS) legislation authorized nearly $1 billion over five years in new Federal funding for services to strengthen and support families' efforts to provide a safe and nurturing environment for their children. FP/FS funds were to be administered at the Federal level by the Administration on Children, Youth and Families and at the State level by the child welfare agency responsible for administering child welfare services funds. The purpose of this study is to evaluate how States and communities implemented the legislation, the ways in which implementation altered the pre-existing service delivery system, and the effects on service delivery. The report is based on: (1) a review of the FP/FS applications, State plans and 1996 plan updates submitted by each of the 50 States; (2) site visits to 10 States conducted between November 1995 and July 1996; and (3) site visits to 20 communities between September 1996 and June 1997. (two volumes)

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Jagannathan, Dr. K.A.
202-205-4829

PIC ID: 5975

PERFORMER: James Bell Associates, Inc.
Arlington, VA

Project REFRESH: Research and Evaluation of Foster Children's Reception into Environmentally Supportive Homes

Little is known about everyday occurrences in foster family homes. Assessment tools and evaluation protocols are needed to examine factors affecting quality and satisfaction with care in kinship/non-kinship placements. Project REFRESH, a three- year study, identified factors affecting quality of care and children's integration into kinship/non-kinship foster settings. Objectives were to: (1) evaluate quality of care, (2) evaluate participants' satisfaction with care, (3) assess perceived quality and quantity of caregiver training, (4) test an integration model, (5) develop an assessment tool and evaluation protocol, and (6) disseminate project results. This case study design assessed children's integration processes and juxtaposed integration and quality, and satisfaction with care, in kinship/non-kinship settings. Variables examined during family interviews were: (1) status, (2) time, (3) space, (4) resources and (5) language. Members and associated caseworkers of 60 kinship/non-kinship families served as data sources in family interaction assessment. A subsample of 10 families/caseworkers participated in a qualitative component. Data collection methods included (1) interviews, (2) questionnaires, (3) observations, (4) children's drawings, (5) rating scales and (6) videotaped family interaction sessions. Based on the findings, an assessment tool and evaluation protocol were developed and tested to aid in placement decisions. An immediate benefit is a richer understanding of kinship and non-kinship foster placements. The ultimate benefit is the creation of frameworks within which to assess the quality of services to foster children.

AGENCY SPONSOR: Administration on Children, Youth and Families

FEDERAL CONTACT: Wave-Rice, Geneva
202-205-8654

PIC ID: 6851

PERFORMER: University of Oregon, Family Studies Center
Corvallis, OR

Strengthening Homeless Families: A Coalition-Building Guide

The purpose of this Coalition-Building Guide is to assist shelters and community-based agencies to plan, develop and implement collaborative services designed to strengthen homeless families and create systematic change within the community. The Guide is intended to serve as a self-guided planning tool. The worksheets contained throughout the document may be used individually by shelters and community-based agencies to examine respective issues, resources, or plans, or they may be used collectively by a coalition of agencies seeking to enhance their collaborative efforts. The planning process described in this Guide is designed to support collaborative partnerships among the traditional and non-traditional allies of shelters. Such agencies include medical and mental health agencies, housing authorities, child and family services agencies, churches, schools, private businesses, philanthropic organizations, law enforcement and advocacy organizations. Chapter one provides a brief overview of the multiple needs of homeless families and children and frames the rationale for a comprehensive, collaborative, community-based approach to strengthening homeless families and child abuse prevention efforts. Chapter two discusses the strategic planning process--the conceptual framework for coalition building. Chapter three is a step-by-step implementation guide to collaboration among shelters and traditional and non-traditional allies within the community. Finally, the Appendix contains support materials and suggested additional reading. (See PIC ID 5040)

AGENCY SPONSOR: Administration on Children, Youth and Families

FEDERAL CONTACT: Gaffney, Joan
202-205-8910

PIC ID: 5040.1

PERFORMER: Circle, Inc.
McLean, VA

Strengthening Homeless Families: An Annotated Resource Guide

This Annotated Resource Guide is one of two documents to assist shelter staff to enhance their understanding of child abuse and neglect; to create temporary housing environments that support and strengthen families; and to build collaborative, community-based approaches to preventing child abuse and neglect. The Guide provides an overview of the multiple needs of homeless families and children and contains brief descriptions of programs (currently being implemented by shelters) to strengthen families. The Guide is organized into four chapters. Chapter one presents a brief overview of homelessness in the U.S., including a discussion of the risk of child abuse and neglect among homeless families. This chapter also outlines the purpose and organization of the Guide. Chapter two provides an overview of the signs and symptoms of child abuse and neglect as well as reporting requirements when abuse or neglect is suspected. Chapter three delineates the complex needs of families and children and briefly describes a variety of programs which have been implemented to address these needs. Chapter four discusses the importance of collaborative, community-based service delivery for families and children. This chapter serves as an introduction to the companion document Strengthening Families: A Coalition-Building Guide. (See PIC ID 5040.1)

AGENCY SPONSOR: Administration on Children, Youth and Families

FEDERAL CONTACT: Gaffney, Joan
202-205-8910

PIC ID: 5040

PERFORMER: Circle, Inc.
McLean, VA

Foster Care

Children Placed in Foster Care With Relatives: A Multi-state Study

This study examines (1) the outcomes for children and families in the various configurations of relative foster care compared to the configurations of non-relative foster care, and (2) the associated costs of relative foster care compared to the costs of non-relative foster care. An initial survey was conducted in nine selected States to determine the specificity of the information available at the State and local levels pertaining to children currently placed in relative foster care, their birth families, the relatives responsible for their care, and the information pertaining to children formerly in relative foster care. The specific information obtained in this survey was used in the design of a national study to examine children placed in relative foster care compared to those placed in non-relative foster care. A review of the literature on relative foster care indicated that the incidence of kinship placements was affected by the changing characteristics of the general populations of nonrelative and kinship caregivers as well as by the population of children in need of substitute care. The demographic and geographic characteristics of the entry patterns for kinship care differed from those associated with traditional foster parents. At the same time, the roles and responsibilities of all foster parents became more demanding, with little indication that the agency policies and practices have correspondingly adapted to the need for increasing levels of support.

AGENCY SPONSOR: Administration on Children, Youth and Families

FEDERAL CONTACT: Flanzer, Sally
202-205-8914

PIC ID: 5846

PERFORMER: TransAmerica Systems, Inc.
Washington, DC

Head Start

Descriptive Study of Children and Families Served by Migrant Head Start

This study describes the implementation of 26 Head Start Migrant programs. It characterizes the current Migrant Head Start (MHS) client population; provides an overall description of the MHS service delivery system and operational issues affecting both the nationwide service delivery system and local centers; and estimates the universe of need for MHS services and proportion of MHS-eligible families currently served. Primary data collection activities included the Migrant Head Start Parent Survey; the MHS Program Directors' Surveys; the MHS Survey of Social Service Providers and the MHS Health Records Review. In addition, a special analysis was conducted of multi-year data from the National Agricultural Workers Survey (NAWS) to determine the extent to which the current system of service delivery is available to the overall population of eligible families and whether there were major demographic or socioeconomic differences between the population enrolled in the MHS program and the overall MHS-eligible population. The findings revealed the demographic and socioeconomic characteristics of the population served by MHS fairly closely approximate those of the general population of families eligible for MHS. However, the profile of families served by MHS programs in "upstream" areas more closely approximate the profile of the overall MHS-eligible population than does the profile of families served in "home base" areas. Other findings indicate the need for MHS services greatly exceeds system capacity and conducting a risk assessment of family needs could assure that MHS services reach those children and families among the MHS-eligible population who are at highest risk.

AGENCY SPONSOR: Administration on Children, Youth and Families

FEDERAL CONTACT: Lopez, Michael
202-205-8212

PIC ID: 4974

PERFORMER: Aquirre International
San Mateo, CA

Evaluation of the Head Start Family Service Center Demonstration Projects

This project conducted an evaluation of the 41 Family Service Center Demonstrations through a consortium of local evaluators. The contractor provided coordination, technical assistance and analysis on common data elements across sites to yield a coordinated and integrated summary of process and impact evaluations. The consortium approach ensured a consistent and technically sound method of evaluating these demonstrations of how Head Start can collaborate with community programs to meet the needs of Head Start families dealing with problems such as illiteracy, substance abuse and unemployment. The contractor also reviewed local evaluation reports to identify lessons to be learned.

AGENCY SPONSOR: Administration on Children, Youth and Families

FEDERAL CONTACT: Doan, Henry, Ph.D.
202-260-2667

PIC ID: 4394

PERFORMER: Abt Associates, Inc.
Cambridge, MA

Serving Homeless Families: Descriptions, Effective Practices, and Lessons Learned

In 1993, the Head Start Bureau (HSB) of the Administration on Children, Youth and Families funded 16 Head Start grantees to implement demonstration projects for homeless children and their families. This report provides the following information about the demonstration projects: (1) the characteristics of the projects and families served, (2) critical issues relevant to project implementation, (3) challenges encountered and effective practices with respect to each issue, and (4) key lessons learned.

AGENCY SPONSOR: Administration on Children, Youth and Families

FEDERAL CONTACT: Lopez, Michael
202-205-8212

PIC ID: 5598

PERFORMER: National Head Start Training and Technical Assistance Center
Arlington, VA

Welfare Reform

Diversion as a Work-Oriented Welfare Reform Strategy and Its Effect on Access to Medicaid: An Examination of the Experiences of Five Local Communities

This project collected information from all States and the District of Columbia regarding the policies and practices that constitute diversion programs and/or activities under the Temporary Assistance for Needy Families (TANF) program. Diversion programs are defined as efforts to address the immediate needs of families seeking cash assistance in ways that avoid enrolling the families in TANF. More detailed case studies were conducted in five local communities in order to document actual implementation and operation of diversion policies and activities. A major focus of the study was an examination of linkages between Medicaid enrollment and diversion programs/activities. The study also examined whether and how local communities and institutions, particularly traditional safety net providers, might be affected by diversion programs. The project addressed the following issues: (1) how State diversion programs are being conceived, structured and implemented; (2) the effects of these programs/activities on Medicaid enrollment; and (3) how local community institutions are affected, particularly by Medicaid enrollment rates. The researchers found that 31 States had implemented at least one diversion program and six States operated two types of diversion programs. They report that formal diversion efforts represent one of the many approaches States are using to shift to a more work-oriented, transitional cash assistance program. The researchers categorized diversion programs and activities into three types: (1) lump sum payment programs, (2) applicant job search, and (3) exploration of alternative resources. Primarily because the programs and activities are relatively new, little is known about their effects on families and their implications for other programs, such as Medicaid. In examining local policies and practices, the researchers concluded that there is substantial potential for diversion programs to reduce families' access to Medicaid. (See PIC ID 6759)

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Campbell, Nancye
202-401-5760

PIC ID: 6759.1

PERFORMER: George Washington University
Washington, DC

The Struggle to Sustain Employment: The Effectiveness of the Post-Employment Services Demonstration

This report serves an update on the effectiveness of the Postemployment Services Demonstration (PESD) program's promotion of employment and reduction of welfare dependency over a two-year period, using administrative records data on program enrollees. Key findings related to the program have been that: (1) extensive outreach and rapid follow-up enabled case managers to reach most clients and to establish prompt communications; (2) overall levels of employment among sample members were fairly high in all four sites; (3) overall, the program had little effect on increasing earnings, reducing welfare, or promoting the move toward self-sufficiency. In this comprehensive study of the PESD programs and their client population, operational lessons were identified that can serve as a guide for other programs considering the provision of job retention services. Recommendations are that programs should: (1) attempt to tailor services to meet client needs and target clients appropriately for different types of job retention services; (2) simplify service delivery mechanisms to enable program staff to focus more on coordinating services and meeting other client needs; (3) form closer links with employers, so that case managers or other staff could help resolve at least some work-related issues; and (4) assess carefully what services their programs currently offer and make changes to fill current gaps in the system, when considering adding job retention assistance to their current set of services.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Wolf, Lawrence
202-401-5084

PIC ID: 5974

PERFORMER: Mathematica Policy Research, Inc.
Plainsboro, NJ

In-Progress Evaluations

Child Care

National Study of Child Care for Low Income Families

This project will study the low income child care market in 25 communities in 17 States with a sub-study to examine the family child care market in 5 neighborhoods drawn from these communities. In addition, the project will conduct a survey of 2,500 low-income families in the same 25 communities to determine how child care decisions are made and to assess the effects of child care subsidies on their choices.The information provided from the study will help inform the issues surrounding subsidized child care and its implementation by the States, with particular attention to the provisions in the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) over time, as well as how significant shifts in welfare policy and programs affect the child care market for welfare recipients and the working poor at the community level. Additionally, this project will conduct a survey of 2,500 low-income families in the same 25 communities to determine how child care decisions are made and assess the effects of child care subsidies on their choices.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Jakopic, Richard
202-205-5930

PIC ID: 6845

PERFORMER: Abt Associates, Inc.
Cambridge, MA

EXPECTED DATE OF COMPLETION: 09/29/2002

Child Support

Multisite Evaluation of OCSE Responsible Fatherhood Programs and MIS Development

This contract will provide technical assistance to assist States with appropriate MIS and data collection in order to facilitate an evaluation and the other contract will evaluate the projects. The projects are eight separate State demonstration projects which attempt to facilitate increased payment of child support through assistance to low or no income fathers who owe child support. Services involve the following: (1) child support services, (2) training, (3) related social services, (4) case management, (5) fatherhood motivation, and (6) access and visitation assistance.

AGENCY SPONSOR: Office of Child Support Enforcement

FEDERAL CONTACT: Arnaudo, David
202-401-5364

PIC ID: 7055

PERFORMER: The Lewin Group, Fairfax, VA; Policy Studies, Inc, Denver CO; and Center for Policy Research, Denver CO

EXPECTED DATE OF COMPLETION: 09/20/2000

Partners for Fragile Families

The Partners for Fragile Families Project strives to assist low-income unemployed, and underemployed, mainly minority fathers to work with the mothers of their children to become "team" parents and share the legal, financial and emotional responsibilities of parenthood. To achieve these goals, the grantee will develop, test and implement Fatherhood Development Workshops, grassroots organizations working with low income fathers, develop and implement a Peer Learning College for child support enforcement professionals. These efforts serve to encourage, support, and assist child support agencies that have recognized the barriers these fathers face to becoming responsible fathers. The Ford Foundation is also providing funding for this project.

AGENCY SPONSOR: Office of Child Support Enforcement

FEDERAL CONTACT: Pontisso, Debra
202-401-4548

PIC ID: 6844

PERFORMER: National Center for Strategic Nonprofit Planning and Community
Washington, DC

EXPECTED DATE OF COMPLETION: 09/30/2000

Study of the Impact of the Child Support Enforcement (CSE) Program on Avoiding Costs to Public Programs

The purpose of this study is to develop a conceptual framework for determining cost avoidance that would be appropriate for use in the Federal and State budgetary and appropriation processes. This study will also assess the current technology in terms of the development and potential application of a cost-avoidance methodology for the Child Support Enforcement program. This study will result in contractor recommendations as to how to prioritize the various components of cost avoidance, i.e., which mechanical and behavioral aspects of cost avoidance should be addressed first, and the sequence of steps to take to quantifying the costs avoided for each area. The contract objectives are: (1) review the literature on cost avoidance and prepare an annotated bibliography; (2) identify academics, research firms and States conducting child support cost avoidance related research; (3) assess microsimulation models; (4) assess the capacity of State administrative databases to measure cost avoidance; and (5) identify the most promising cost avoidance model or models for further testing and refinement.

AGENCY SPONSOR: Office of Child Support Enforcement

FEDERAL CONTACT: Maller, Gaile
202-401-5368

PIC ID: 6842

PERFORMER: The Lewin Group
Fairfax, VA

EXPECTED DATE OF COMPLETION: 03/01/2000

Community Services

Job Opportunities for Low -Income Individuals (JOLI) Program

This project will provide training and technical assistance and evaluation assistance to grantees funded under the Job Opportunities for Low-Income Individuals Program (JOLI). The services provided will assist the grantees in the development of their project designs and in the finalization of their evaluation plans. These plans will provide the Office of Community Services (OCS) with useful insights into both project outcomes and processes. In addition, the services provided will assist OCS to effectively evaluate the impact of the demonstration and to disseminate the project results to the Congress and other interested parties.

AGENCY SPONSOR: Office of Community Services

FEDERAL CONTACT: Lewis, Nolan
202-401-5282

PIC ID: 6430

PERFORMER: Trans-Management Systems Corporation
Washington DC

EXPECTED DATE OF COMPLETION: 09/29/2002

Family Services

Family Investment Program (FIP)

This study continues the evaluation of a welfare reform demonstration combining program changes designed to ease a family's transition from welfare to work with strict requirements that recipients participate, the Family Investment Agreement (FIA), under Iowa's employment program. The FIA details the steps a family will take to become self-sufficient and establishes a time frame for doing so. See also PIC ID 6762.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Wright, Girley
202-401-5070

PIC ID: 6761

PERFORMER: Iowa Department of Human Services
Des Moines, IA

EXPECTED DATE OF COMPLETION: 04/30/2001

Florida Family Transition Program (FTP) Evaluation Project

This project continues an evaluation of a welfare reform waiver demonstration in Escambia County, Florida, that includes a 24-month time limit on cash assistance (with some exceptions), increased earned income disregards and asset limits, increased eligibility for two-parent families, and school attendance requirements for teenagers. The evaluation will produce process, impact, and cost-benefit studies using a random-assignment experimental design, and will examine the effects of FTP on individuals' participation in program activities, welfare use, and self-sufficiency.

AGENCY SPONSOR: Office of Planning, Research, and Evaluation

FEDERAL CONTACT: Yaffe, Alan
202-401-4537

PIC ID: 6820

PERFORMER: Florida Department of Children and Families
Tallahassee, FL

EXPECTED DATE OF COMPLETION: 04/30/2000

Home Visiting Services Demonstration

The demonstrations will test whether adding weekly home visitor services will result in helping first-time teen mothers better support themselves and their children while promoting positive parenting and reductions in repeat childbearing. The home visitors are paraprofessionals. The demonstration sites are Chicago, Illinois; Dayton, Ohio; and Portland, Oregon.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Wright, Girley
202-401-5070

PIC ID: 5980

PERFORMER: University of Pennsylvania, Graduate School of Education
Philadelphia, PA

EXPECTED DATE OF COMPLETION: 11/30/2000

Jobs-Plus: Community Revitalization Initiative for Public Housing Families

This is a seven and one-half year demonstration program aimed at dramatically increasing employment, earnings and job retention among the working-age residents of family housing developments, a large percentage of whom are on public welfare or at risk of dependency. The program supports the planning, development, implementation and evaluation of locally-based approaches to providing saturation-level employment opportunities, including a combination of training and supportive services, financial and other incentives (occasioned by the welfare reform and new public housing policies), and vigorous efforts to rebuild and strengthen the community in support of work. The bottom line question for the Jobs-Plus Demonstration is: Does the program achieve its primary goal of dramatically increasing employment and earnings among public housing residents? And, does a large increase in employment and earnings lead to a better quality of life for residents? Questions concerning the sites' implementation strategies and experiences are also important and will be a major focus of the research. The evaluation design developed for the demonstration combines experimental and quasi-experimental methods in an unusually rigorous approach for studying the effectiveness of a place-based comprehensive social intervention. (It uses randomly-selected sets of treatment and comparison sites.) The study will use administrative records data as well as survey data covering a wide variety of outcomes. It will examine whether the program's impacts vary across sites and whether certain program strategies are likely to yield better results. The evaluation will include comprehensive cost and benefit-cost analyses.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Faris, Hossein, Ph.D.
202-205-4922

PIC ID: 6835

PERFORMER: Manpower Demonstration Research Corporation
New York, NY

EXPECTED DATE OF COMPLETION: 12/31/2003

National Evaluation of Family Support Programs

In September 1994, the Administration on Children, Youth, and Families (ACYF) awarded a contract to conduct a national evaluation of Family Support Programs. The evaluation stems from legislation that provides funding to States for family support and preservation efforts. It represents an innovative attempt to combine knowledge derived from prior and ongoing research with new research studies designed to enhance our understanding about the effects of different programmatic approaches to family support. The study has three parts: (1) a comprehensive review of what is currently known about family support programs and their effects, (2) a phase that focuses on planning and implementing a series of research studies designed to fill the gaps in understanding programs and their effects, and (3) a synthesis of the two earlier parts. The evaluation is a five-year effort. The program and research reviews conducted in the first year will guide the formulation of a research strategy for the remaining years of the project. Up to ten new evaluation studies will be designed to fill gaps in the current knowledge base. These evaluations will be implemented in the second, third and fourth years of the study. The work of the final year will combine the information gained in the preceding years into an integrated and comprehensive report.

AGENCY SPONSOR: Administration on Children, Youth and Families

FEDERAL CONTACT: Bruce-Webb, Mary, Ph.D.
202-205-8628

PIC ID: 5848

PERFORMER: Abt Associates, Inc.
Cambridge, MA

EXPECTED DATE OF COMPLETION: 09/30/2000

Prenatal and Early Childhood Nurse Home Visitation Program --Replication/Dissemination

The Administration for Children and Families (ACF) and the Department of Justice (DOJ), Office of Juvenile Justice and Delinquency Prevention are supporting this initiative. The project allows for data collection and evaluation of an initiative to replicate and disseminate the nurse home visiting model. The model has been tested through randomized trials and found to be effective in improving outcomes for mothers and their children on a number of important outcome measures, including: (1) educational attainment, (2) employment, (3) welfare dependency, (4) parenting attitudes, and (5) subsequent pregnancies. The DOJ funded a grant to support technical assistance and training to replicate the model in selected sites. This project supports the evaluation component of the initiative to test the effectiveness of the replication process within normal operating environments. The initiative will answer questions pertaining to: (1) whether programs are implemented with fidelity to the original program model; (2) whether the program is reaching the target population of at-risk, low-income pregnant women; (3) the aspects of the model that are most difficult to implement and maintain; (4) the factors explaining site variation in program fidelity; and (5) the outcomes for pregnant women and families enrolled in each site.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Wright, Girley
202-401-5070

PIC ID: 6757

PERFORMER: University of Colorado Health Sciences Center
Denver, CO

EXPECTED DATE OF COMPLETION: 12/31/2001

Foster Care

Assessing the Quality of Foster Family Care: An Initiative for the Integration of Research and Practice

The underlying mission of this project is to promote quality in the caretaking environments of foster children. The overall goal of the research is to fill the gap in the literature on foster family care by examining the individual characteristics of foster parents across domains, as well as the environmental characteristics of the home. The research design will include a comparison of relative and non-relative foster homes, and a comparison of African-American and Caucasian foster homes. The participants in this study will be drawn from the pool of foster parents and children in Prince George's and Montgomery Counties, MD, which border three quadrants of Washington, D.C. Both counties are socioeconomically and ethnically diverse, and have had an increase in their high-risk populations due to migratory patterns from the District and foreign countries. It is anticipated that 120 families will be recruited from each county for a total of 240 families. Project results will be presented at national and local conferences, submitted to professional journals, and disseminated to policy and program development entities. A major objective of the proposed project is to produce an instrument that can be utilized by social service staff to assess the quality of foster home placements.

AGENCY SPONSOR: Administration on Children, Youth and Families

FEDERAL CONTACT: Wave-Rice, Geneva
202-205-8654

202-205-8654

PIC ID: 6850

PERFORMER: University of Maryland, Institute for Child Study
College Park, MD

EXPECTED DATE OF COMPLETION: 09/30/2000

Factors Related to the Quality of Family Foster Care

The purpose of this study is to determine the quality of the foster care experience and the factors that influence it, based on data collected from a sample of 500 families whose children spent time in foster care in Wayne County, Michigan, during 1993. The study examines the relationship between the agency and services characteristics (e.g., private versus public agency, caseload size, staff turnover, continuity of case services, provision of family preservation services, and use of kinship care) and quality foster care. The five components of the quality of foster care experiences are: (1) the health and well-being of the child while in care; (2) maltreatment in care; (3) family continuity; (4) types and numbers of placements; and (5) duration of care and recidivism. Examining the experiences of families whose child(ren) entered care in 1993 will allow analysis of the entire stay in foster care for the majority of foster children, and analysis of a four year span of experiences for those children who remain in care through the end of the study or return to care during that time frame. Analysis of these data will proceed in three stages: (1) determination of the quality of the foster care experience for the children in the sample; (2) multivariate analysis of the factors leading to different levels of quality; and (3) development of alternative models of foster care which maximize the quality of foster care experiences for different types of families. Characteristics of the family, characteristics of the child, and reasons for the child coming into care will be included in the model. This research aims to discover which factors are most significant in affecting the foster care experience for which types of children and families. This study will produce a handbook that can be used for informing agency policy, improving agency practice and training agency staff.

AGENCY SPONSOR: Administration on Children, Youth and Families

FEDERAL CONTACT: Wave-Rice, Geneva
202-205-8654

202-205-8654

PIC ID: 6849

PERFORMER: Ryan, Patricia, Eastern Michigan University
Ypsilanti, MI

EXPECTED DATE OF COMPLETION: 09/30/2000

How Decisions to Change the Case Plan Goal Are Initiated

The Jane Addams College of Social Work, in collaboration with the National Resource Center for Permanency Planning at the Hunter College School of Social Work of the City University of New York, the Illinois Department of Children and Family Services, and the New York City Child Welfare Administration proposes a three year study of children entering State custody as infants in Chicago and New York City. The purpose of the study is to identify the factors which facilitate or delay changes in the case plan goal. Data will be collected through in-depth interviews with caseworkers responsible for selected cases. Approximately 600 cases will be selected for interviews to be conducted around the child's anniversary date of entering State custody. Half of the children in each cohort will be living with relatives and others will be living in non-related family foster care at the time of the first case selection. Caseworkers will complete brief follow-up questionnaires at 6 months and 12 months following the initial interviews to determine if the case plan goal changed, who initiated the change, and what factors facilitate or delay the change. In this way, barriers and facilitating conditions which occur in a child's second, third and fourth year in care will be identified. Key informants will be interviewed in the final year of the project to develop an understanding of systems factors which appear to facilitate or hinder changing the case plan goal. Key informants and the questions they are asked will be determined through analysis of data collected at the case level. Products of this study will include three major reports and policy and practice recommendations for facilitating permanence for children entering State custody as infants.

AGENCY SPONSOR: Administration on Children, Youth and Families

FEDERAL CONTACT: Wave-Rice, Geneva
202-205-8654

202-205-8654

PIC ID: 6848

PERFORMER: Jane Addams College of Social Work, Univ. of Illinois at Chicago
Chicago, IL

EXPECTED DATE OF COMPLETION: 09/30/1999

National Longitudinal Study of Children and Families in the Child Welfare System

The purpose of this study is to describe the outcomes experienced by children and families who come to the attention of the child welfare system, and to gain an understanding of the factors, including system-level and service factors, as well as child and family characteristics, that contribute to those outcomes. The study will select a nationally representative sample of 6,000 children upon entry into the child welfare system. Information on this sample will be collected at baseline and at three annual follow-up interviews from the children and their caregivers, caseworkers, and other agency personnel and service providers. Public use data sets will be prepared following each wave of data collection.

AGENCY SPONSOR: Administration on Children, Youth and Families

FEDERAL CONTACT: Bruce-Webb, Mary, Ph.D.
202-205-8628

PIC ID: 6748

PERFORMER: Research Triangle Park
Research Triangle Park, NC

EXPECTED DATE OF COMPLETION: 09/30/2003

Partner and Father Involvement in the Lives of Low-Income First Time Mothers and Their Children

This project will investigate the role that fathers and partners play in improving the material, emotional, and developmental well-being of low-income women and children. It consists of a set of secondary analyses using data from three longitudinal experiments of a program of prenatal and infancy home visitation serving first time mothers from various ethnic and racial groups.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Wolf, Lawrence
202-401-5084

PIC ID: 6799

PERFORMER: Children's Hospital
Denver, CO

EXPECTED DATE OF COMPLETION: 09/30/2000

Prevention of Foster Care Placement of Children at Risk for Domestic Violence

The Family Advocate Project (FAP) will build on the existing programs operated by the Family Intervention Center of the Children's Hospital of Pittsburgh, which provides medical and psychosocial evaluations to battered women and their children. The study will examine 150 mothers assigned to either a study or a control group. The mothers in the study group will receive intensive services in the areas of counseling, housing assistance, legal assistance and health care. Upon entry into the study, the mothers will undergo an extensive evaluation that will focus on control, maternal support, depression symptoms and attitudes toward discipline. The study will look at ways to alleviate the emotional trauma of battered women, and will explore whether the provision of support services to increase self-esteem and coping skills can prevent out-of-home placement or reduce the length of time children spend in foster care. FAP also will develop a replicable foster care prevention model. Finally, FAP is following both the experimental and control groups for a specified time after services are delivered.

AGENCY SPONSOR: Administration on Children, Youth and Families

FEDERAL CONTACT: Wave-Rice, Geneva
202-205-8654

202-205-8654

PIC ID: 4378

PERFORMER: Children's Hospital
Pittsburgh, PA

EXPECTED DATE OF COMPLETION: 10/01/1999

Head Start

Descriptive Study of Families Served by Head Start

This three-year descriptive study will provide information on a nationally representative sample of families served by Head Start in forty programs across the country. Through a survey and more intensive case study methods, the study will chart families' demographics, strengths, needs, expectations and experiences within Head Start programs, as well as programmatic efforts to join in partnership with families. (See PIC ID 6331.1)

AGENCY SPONSOR: Administration on Children, Youth and Families

FEDERAL CONTACT: Tarullo, Louisa Ed.D.
202-205-8324

PIC ID: 6331

PERFORMER: Abt Associates, Inc.
Cambridge, MA

EXPECTED DATE OF COMPLETION: 09/30/2000

Descriptive Study of Head Start Bilingual/Multicultural Program Services

Head Start currently serves a diverse range of bilingual and multicultural children and families, and has developed innovative strategies to serve the unique needs of these populations. As the number of bilingual and multicultural children and families increases, several issues must be addressed. First, the number, geographic distribution, and sociodemographic characteristics of the Head Start eligible population for different cultural and linguistic groups must be assessed regionally and nationally. The number and nature of bilingual and multicultural children actually served by the Head Start program must also be determined as well as the range of bilingual and multicultural services provided nationally. Finally, there is need for an in- depth assessment of the service models, staff training approaches, community partnerships, and administrative plans and processes of a sample of 30 Head Start programs that have developed innovative methods for addressing diverse cultural and linguistic needs.

AGENCY SPONSOR: Administration on Children, Youth and Families

FEDERAL CONTACT: Joseph, Gail
202-205-8713

PIC ID: 5845

PERFORMER: STRA, Inc.
Washington, DC

EXPECTED DATE OF COMPLETION: 09/30/2000

Early Head Start Research and Evaluation National Study

The Early Head Start National Study will evaluate the effectiveness of the Early Head Start (EHS) program in fifteen diverse communities: Brattleboro, Vermont; Pittsburgh, Pennsylvania; New York, New York; Washington, D.C.; Sumter, South Carolina; Russellville, Arkansas; Marshalltown, Iowa; Kansas City, Kansas; Kansas City, Missouri; Denver, Colorado; Logan, Utah; Jackson, Michigan; Auburn, Washington; Grandview, Washington; and Venice, California. The study will examine child, family, staff and community outcomes in a sample of 3,400 children and their families, who will be randomly selected into program and comparison groups when the mothers are pregnant or children are under 12 months of age. Assessments of children, families and child care environments will be made when children are 14, 24, and 36 months of age. Service use interviews will be conducted every six months, and programs will be visited each year. The study will produce the following reports: (1) Descriptive Study of EHS Programs; (2) Study of Program Variations; (3) Pathways to Early Head Start Quality; (4) Interim Study of Outcomes; (5) Longitudinal Study of EHS Outcomes; and (6) Selected Policy Papers.

AGENCY SPONSOR: Administration on Children, Youth and Families

FEDERAL CONTACT: Tarullo, Louisa Ed.D.
202-205-8324

PIC ID: 3570

PERFORMER: Mathematica Policy Research, Inc.
Plainsboro, NJ

EXPECTED DATE OF COMPLETION: 09/30/2000

Evaluation of the Head Start/Public School Early Childhood Transition Demonstration

This evaluation of the Head Start/Public School Early Childhood Demonstration projects will assess the effectiveness of providing comprehensive, continuous and coordinated services to Head Start families and children from the time of Head Start enrollment through the third grade. Working in concert with local evaluators, the contractor will develop a set of common data collection instruments to be used across all sites. The project will provide data regarding the effectiveness of the Transition Project models in maintaining the gains that children and families achieve while in Head Start. The evaluation and the demonstrations were mandated by the Head Start reauthorization legislation. Other studies completed during the ten years prior to 1992, notably the Head Start Transition Study and Developmental Continuity, did not provide information on the experiences or services extended to children after leaving Head Start. Additionally, these studies collected only limited data on families, the institutions and the community. This study is intended to supplement these other studies.

AGENCY SPONSOR: Administration on Children, Youth and Families

FEDERAL CONTACT: Bruce-Webb, Mary, Ph.D.
202-205-8628

PIC ID: 4393

PERFORMER: University of Alabama
Birmingham, AL

EXPECTED DATE OF COMPLETION: 09/30/2000

Welfare Reform

A Study of Infant Care Under Welfare Reform

Twenty-two States have used the new flexibility granted under the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA), to require work of parents whose youngest child is less than one year old. The purposes of this study are to learn more about the policy and program challenges facing States that are encouraging welfare parents with infants to work or attend school, and to build the foundation for future research on programs, policies and strategies that can successfully transition parents from welfare to work while promoting the health and development of infants. To achieve these objectives, the study will examine three central issues: (1) the policies, programs and strategies that States are currently using to transition parents with infants off of welfare and arrange child care for infants; (2) the ways in which parents who are transitioning from welfare to work meet the competing demands of work and family responsibilities and how they meet their infant care needs; and (3) the availability of quality infant care and its impact on parents' ability to meet welfare program requirements. The study includes the three following phases: (1) information-gathering, (2) in-depth study, and (3) research design.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Jakopic, Richard
202-205-5930

PIC ID: 7113

PERFORMER: Mathematica Policy Research, Inc.
Washington, DC

EXPECTED DATE OF COMPLETION: 03/30/2001

Achieving Change for Texans

This project continues an evaluation of the State of Texas' original welfare reform demonstration. The demonstration consists of four major components: (1) a number of policies implemented Statewide addressing such recipient responsibilities as immunization for children, school attendance and adherence to a personal responsibility agreement; (2) a number of policies implemented in counties operating JOBS, the primary feature of which is differential benefit time limits based on consideration of work experience and the need for education; (3) a number of policy options implemented in four counties, providing for individual development accounts and fill-the-gap budgeting; and (4) a one-county pilot offering a check for $1,000 in lieu of regular Temporary Assistance for Needy Families (TANF), with no re-application for benefits for one year.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Maniha, John
202-401-5372

PIC ID: 6765

PERFORMER: State of Texas, Department of Human Services
Austin, TX

EXPECTED DATE OF COMPLETION: 03/31/2002

Assessing Effective Welfare-to-Work Strategies for Domestic Violence Victims and Survivors in the Options/Opciones Project

This 5-year (1997-2002) research project will study the effective strategies in addressing the needs of abused women as they try to enter the labor market. This project will document the needs of battered girls and women on welfare, and will identify successful strategies employed to eliminate violence and exit welfare.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: MacKenzie, Mary Ann
202-401-5272

PIC ID: 6833

PERFORMER: Taylor Institute
Chicago, IL

EXPECTED DATE OF COMPLETION: 09/29/2002

California Welfare Reform Impact Evaluation

This demonstration will attempt to estimate the impact of California's Temporary Assistance for Needy Families (TANF) program. Generally, impacts will be assessed by comparing outcomes in the post-TANF period with the pre-TANF period. The impact of various county programs may also be examined by comparing outcomes among the counties. In developing models to estimate impacts, California will use a 10 percent Statewide sample of welfare recipients. These samples date back to 1987, providing a rich database to use to test the models. The sample data consist of Department of Social Services information on Aid to Families with Dependent Children (AFDC), Supplemental Security Income (SSI), Medi-Cal and foster care. These data have been supplemented by data on unemployment and disability insurance, and Department of Health Services data on births. The major research questions concern the impact of State's TANF program on self-sufficiency, family composition, and child well-being. To the extent possible, the impacts of TANF on different subgroups will be considered. Subgroups will include racial and ethnic subgroups, as well as urban and rural subdivisions. Attempts will also be made to determine the impacts of differing implementation of TANF among the counties.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Sternbach, Leonard
415-437-7671

PIC ID: 5548

PERFORMER: California Department of Social Services
Sacramento, CA

EXPECTED DATE OF COMPLETION: 03/31/2002

Capitalizing the Bridge from Welfare to Independence (CBWWI)

This project is designed to expand the employment and training services provided by Goodwill Industries by constructing new centers in four counties in southwest Florida and six parishes in southeast Louisiana. Once constructed, the centers are expected to be self-supporting (i.e., no need for continuing public support) by utilizing the business activity and payroll generated by the donated goods business.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Wright, Girley
202-401-5070

PIC ID: 6755

PERFORMER: Goodwill Industries of Manasota, Inc., Sarasota, FL and Goodwill Industries of Acadiana, Inc., Scott, LA

EXPECTED DATE OF COMPLETION: 11/30/2000

Child Impact Studies

This project augments the existing welfare reform demonstration evaluations in five States (Connecticut, Florida, Indiana, Iowa and Minnesota) to assess the effects of different welfare reform approaches on child well-being outcomes, including school achievement, behavioral problems, and health status. The effect of intervening mechanisms, such as the quality and regularity of the home environment, child care arrangements, and parental employment and income, will also be examined.

AGENCY SPONSOR: Office of Planning, Research, and Evaluation

FEDERAL CONTACT: Yaffe, Alan
202-401-4537

PIC ID: 6847

PERFORMER: Multi-Professional Services Contracts

EXPECTED DATE OF COMPLETION: 09/29/2001

Evaluation of Arizona Employing and Moving People Off Welfare and Encouraging Responsibility Program (EMPOWER)

Under this Aid to Families with Dependent Children (AFDC) and Temporary Assistance for Needy Families (TANF) demonstration, recipient families are encouraged to become self-sufficient by: (1) time-limiting cash assistance for adult recipients, (2) imposing a family cap, (3) extending transitional Medicaid and child care to 24 months, (4) eliminating the 100 hour rule for two parent families, (5) requiring unwed minor parents to live with a responsible adult, and (6) requiring 13 to 16 year old parents to participate in Job Opportunities and Basic Skills (JOBS).

AGENCY SPONSOR: Office of Planning, Research, and Evaluation

FEDERAL CONTACT: Sternbach, Leonard
415-437-7671

PIC ID: 6818

PERFORMER: Arizona State Department of Economic Security
Phoenix, AZ

EXPECTED DATE OF COMPLETION: 12/31/2000

Evaluation of Community-based Job Retention Programs

This his project includes two components. In one, the project will provide an implementation analysis and outcome findings for current and former welfare recipients receiving employment retention and post-employment services through the GAPS program. The services will be provided to about 600 employed TANF recipients through five community-based organizations in the Pittsburgh area that received funding from the Pittsburgh Foundation. A common set of services will be provided but within the context of different existing service delivery systems among the five organizations. The project will describe the experiences of providers and participants, report on the economic success of participants over time, and present lessons for program administrators. The second component will include a descriptive analysis of the Community Solutions program through which the state Department of Human Services contracted for pre- and post-employment services from service providers using performance-based contracting and payments. Providers receive incremental payments when TANF recipient participants attain certain benchmarks including maintaining steady employment for 12 months. This component of the study focuses primarily on the experiences of service providers operating programs under the requirements and payment schedules of the performance-based contract.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Campbell, Nancye
202-401-5760

PIC ID: 6760

PERFORMER: Pittsburgh Foundation
Pittsburgh, PA

EXPECTED DATE OF COMPLETION: 06/30/2001

Evaluation of Los Angeles Jobs-First GAIN

Using experimental methodology, this project will consist of an implementation/process study, impact study and a cost-benefit study. It will evaluate the results of changing Los Angeles GAIN, a human resource focused welfare-to-work program, into Los Angeles Jobs-First GAIN, a labor force attachment strategy. The change involved: (1) strengthening the job club and having case managers make immediate job activity referrals universally; (2) locating job developers in GAIN offices; (3) using goals and performance-based contracts to reinforce the Work First message within GAIN; (4) change program guidelines and staff training to communicate importance of finding employment; and (5) informing enrollees of the financial advantage of even minimum wage jobs.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Wolf, Lawrence
202-401-5084

PIC ID: 6840

PERFORMER: Manpower Demonstration Research Corporation
New York, NY

EXPECTED DATE OF COMPLETION: 09/30/2000

Evaluation of the Employment First Program

This process evaluation will primarily focus on implementation and operation of the Nebraska Employment First Program and will conclude a special study to assess successful case management. In addition, a separate impact evaluation will be carried out comparing an intensive up-front job search strategy with the "traditional" up-front assessment approach.

AGENCY SPONSOR: Office of Planning, Research, and Evaluation

FEDERAL CONTACT: Dubinsky, Michael
202-401-3442

PIC ID: 6826

PERFORMER: Nebraska State Department of Health and Human Services
Lincoln, NE

EXPECTED DATE OF COMPLETION: 09/29/2002

Evaluation of the North Carolina Work First Program

This project will evaluate North Carolina's Work First program which requires TANF families to work towards self- sufficiency. Through Work First, parents can receive short-term training and families can receive child care and other services.

AGENCY SPONSOR: Office of Planning, Research, and Evaluation

FEDERAL CONTACT: Wright, Girley
202-401-5070

PIC ID: 6829

PERFORMER: NC Department of Health and Human Services
Raleigh, NC

EXPECTED DATE OF COMPLETION: 09/29/2000

Front-Line Management and Practice Study

This is a study of Temporary Assistance to Needy Families (TANF) implementation at the local level, and is embedded in the larger SUNY-Albany State Capacity study, which is a 20 State implementation analysis. The principal objective of the Front- Line Management and Practice Study is to evaluate whether front-line workers are implementing the welfare goals and policies established by the States. Locally-based researchers will conduct in-depth observations in three local offices from each of four States. Sites have not yet been chosen, but no two offices will be selected from one county/city. A criterion for site selection dictates that the State give primary emphasis to work and job preparation, thus enabling the researchers to make comparisons among management practices that aim to affect the same sort of policy outcomes. Some sites will be chosen because they use traditional rule-based management and others because they rely on performance-based management.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Dubinsky, Michael
202-401-3442

PIC ID: 6841

PERFORMER: State University of New York at Albany
Albany, NY

EXPECTED DATE OF COMPLETION: 09/30/2001

Impact Study of the New Hampshire Employment Program

This demonstration is designed to determine the impact of New Hampshire's entire Temporary Assistance for Needy Families (TANF) program. It will attempt to determine the effects of TANF on caseload and on employment and earnings, as well as the effects on areas such as foster care placements, child abuse and neglect, homelessness and child support collections.

AGENCY SPONSOR: Office of Planning, Research, and Evaluation

FEDERAL CONTACT: Sternbach, Leonard
415-437-7671

PIC ID: 6828

PERFORMER: New Hampshire DHHS
Concord, NH

EXPECTED DATE OF COMPLETION: 09/29/2002

Indiana Welfare Reform Evaluation Project

This project continues the evaluation of implementation and impacts of the "Indiana Manpower Placement and Comprehensive Training Program" (IMPACT) welfare reform waiver demonstration, now operating under Temporary Assistance for Needy Families (TANF).

AGENCY SPONSOR: Office of Planning, Research, and Evaluation

FEDERAL CONTACT: Jakopic, Richard
202-205-5930

PIC ID: 6869

PERFORMER: Indiana Family and Social Services Administration
Indianapolis, IN

EXPECTED DATE OF COMPLETION: 04/30/2002

Maryland Family Investment Program Evaluation

This is a Statewide process study to examine and document front-line assessment and allocation practices under TANF in Maryland's 24 local jurisdictions. The objective of this analysis is to help clarify the relationship between agency factors and county-level characteristics by describing county-level variation in front-line procedures.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Fucello, Mark
202-401-4538

PIC ID: 6823

PERFORMER: University of Maryland, School of Social Work and Community Planning
Baltimore, MD

EXPECTED DATE OF COMPLETION: 09/29/2000

Minnesota Family Investment Program (MFIP)

Using experimental methodology, this project will evaluate Minnesota's Family Investment Program (MFIP) with the following provisions:(1) increasing disregards below a specified income threshold; (2) requiring long-term recipients to participate in intensive employment/training services, including case management; and (3) consolidating benefits and simplifying rules for TANF, GA and Food Stamps.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Wolf, Lawrence
202-401-5084

PIC ID: 6824

PERFORMER: Manpower Demonstration Research Corporation
New York, NY

EXPECTED DATE OF COMPLETION: 04/30/2001

Minnesota WorkFIRST Program (Track 2)

Using a quasi-experimental, pre-test/post-test comparison group design consisting of both an impact and process study, this study will compare the WorkFirst and MFIP-S programs. WorkFirst uses a rapid labor force attachment strategy versus MFIP-S, which represents a progressive labor force attachment model.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Wolf, Lawrence
202-401-5084

PIC ID: 6825

PERFORMER: Minnesota Department of Human Services
St. Paul, MN

EXPECTED DATE OF COMPLETION: 09/30/2002

Neighbors, Services Providers, and Welfare Reform in Los Angeles County

This project will examine neighborhood variation in the availability of public and private social services throughout Los Angeles County. It will investigate how agencies are adapting to the current and anticipated changes in demand for their services as a result of welfare reform.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Wright, Girley
202-401-5070

PIC ID: 6763

PERFORMER: Rand Corporation
Santa Monica, CA

EXPECTED DATE OF COMPLETION: 02/29/2005

New Hampshire Employment and Training Program Process and Outcome Study

This Process and Outcome Study goes hand-in-hand with the New Hampshire Impact Study. By using surveys of recipients, staff and employers, this process study will determine how Temporary Assistance for Needy Families (TANF) was planned, designed and implemented. There will also be several special studies concerning diversion from welfare, sanctions, child care and transitional case management.

AGENCY SPONSOR: Office of Planning, Research, and Evaluation

FEDERAL CONTACT: Sternbach, Leonard
415-437-7671

PIC ID: 6827

PERFORMER: New Hampshire DHHS
Concord, NH

EXPECTED DATE OF COMPLETION: 09/29/2001

Ohio Works First Evaluation

This demonstration will evaluate the Ohio Works First provisions and Temporary Assistance for Needy Families (TANF) policies which include: (1)completion of a self-sufficiency contract, (2) more generous income disregards, (3) a 36-out-of- any-60 month time limit, and (4) whole family sanctions. In Ohio, local jurisdictions have great flexibility in running their TANF programs, and this evaluation will attempt to determine the differential effects of the various local programs.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Sternbach, Leonard
415-437-7671

PIC ID: 6758

PERFORMER: Ohio Department of Human Services
Columbus, OH

EXPECTED DATE OF COMPLETION: 09/30/2002

Rural Welfare to Work Strategies Project

Although there are extensive bodies of literature both on rural matters and on welfare-related matters, there is relatively little information about rural welfare issues. This report synthesizes available knowledge and, where appropriate, draws inferences from studies about the way that welfare reform is likely to affect rural welfare to work strategies. A long list of research questions remains unanswered. Foremost among them is: what set of strategies is most likely to produce economic self- sufficiency, and for what types of welfare recipients, and under what conditions? Answers to this question can help policymakers, program planners, and community members as they work to accomplish the goals of welfare reform. To build knowledge and research about effective approaches in working with rural populations, the Administration for Children and Families (ACF) awarded planning grants to ten states to help develop and study strategies to move rural families from welfare to work. To help inform the ACF project, this project attempted to cull from the literature pertinent lessons about the intersection between key features of rural areas and factors about welfare recipients' abilities to achieve economic self- sufficiency. Findings are discussed in the following seven areas: rural economic development, workforce development, community commitment, transportation, child care, hard-to-serve welfare to work participants and, restructuring administrative elements of the welfare system.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Dolson, James
202-260-6165

PIC ID: 7247

PERFORMER: Macro International, Inc.
Calverton, MD

EXPECTED DATE OF COMPLETION: 04/30/2001

State Welfare Reform Evaluation Project (Connecticut's Jobs First)

Using experimental methodology, this project will continue an originally planned evaluation of the Jobs First demonstration, later incorporated into the State of Connecticut's TANF plan. The evaluation includes: (1) a short (21 month) eligibility time limit for non-exempt recipients; (2) 24 months of transitional Medicaid; (3) liberalized disregards; (4) "Family Cap", limited eligibility for children born while the family receives assistance; (5) strong job search emphasis, with employability assessment only if a search fails to yield a job; and (6) progressive sanctions for non-compliance.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Wolf, Lawrence
202-401-5084

PIC ID: 6819

PERFORMER: Manpower Demonstration Research Corporation
New York, NY

EXPECTED DATE OF COMPLETION: 04/30/2002

State Welfare Reform Evaluation Track 2

This project, which complements a separately funded evaluation being completed on Iowa's Family Investment Program (FIP), consists of two studies: (1) a study of repeat limited benefit plan (LBP) assignments; and (2) a study of post- employment services. The study of repeat LBP assignments will describe the experiences and outcomes of welfare cases that have been assigned to the LBP more than once. The study of post-employment services will describe and compare standard and enhanced post-employment services and assess their contribution to a client's progress toward self-sufficiency. See also PIC ID 6761.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Wright, Girley
202-401-5070

PIC ID: 6762

PERFORMER: Iowa Department of Human Services
Des Moines, IA

EXPECTED DATE OF COMPLETION: 09/29/2001

Training, Education, Employment, and Management (TEEM) Project

This project will produce a process evaluation of the TEEM project. The TEEM project consolidates TANF and LIHEAP into a single cash assistance program. TEEM includes the following major provisions: (1) a social contract, (2) increased work incentives, (3) sanctions, (4) raised asset limits, and (5) incentives for family stability and marriage.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Wright, Girley
202-401-5070

PIC ID: 6830

PERFORMER: North Dakota Department of Health and Human Services
Bismarck ND

EXPECTED DATE OF COMPLETION: 09/29/2000

Virginia Independence Program

This project evaluates the State's TANF implementation, which continues policies begun under its welfare reform demonstration, Virginia Independence Program (VIP). Among the policies to be studied under the state's VIP are: (1) diversionary assistance, (2) a family cap, (3) time-limited assistance, (4) person responsibility agreements, (5) expanded earned income disregards, (6) school attendance requirements, (7) paternity establishment rules, (8) requiring minor parents to live in adult settings, (9) child immunization requirements, and (10) incentives promoting individual savings accounts and Medicaid and child care benefits.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Maniha, John
202-401-5372

PIC ID: 6831

PERFORMER: Virginia Commonwealth University
Richmond, VA

EXPECTED DATE OF COMPLETION: 09/29/2002

Welfare Policy Typology Project

With the enactment of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), there are few, if any, strict Federal requirements for welfare programs, and States are not required to submit descriptions of their policies in any detail. This project will lay the groundwork for a database that would contain key information about State welfare policies (including Temporary Assistance for Needy Families), State-funded maintenance-of-effort programs, and Federally funded child care assistance programs.

AGENCY SPONSOR: Office of Planning, Research, and Evaluation

FEDERAL CONTACT: Yaffe, Alan
202-401-4537

PIC ID: 6837

PERFORMER: Urban Institute
Washington, DC

EXPECTED DATE OF COMPLETION: 09/30/2000

Welfare Restructuring Project (WRP)

This project continues the evaluation of a welfare reform demonstration project. One of the key features is a time limit that requires some adult recipients to participate in community work experience after fifteen months (for two-parent families) or thirty months (for single-parent families) of receiving cash assistance.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Wright, Girley
202-401-5070

PIC ID: 6764

PERFORMER: State of Vermont, Department of Social Welfare
Waterbury, VT

EXPECTED DATE OF COMPLETION: 09/30/2002

Welfare-to-Work: Monitoring the Impact of Welfare Reform on American Indian Families with Children

The overall purpose of this project is to monitor and document the implementation, and assess the impact of, welfare reform on American Indian families and reservations in Arizona caused by the evolving State and tribal responses to Temporary Assistance to Needy Families (TANF). Extensive demographic, contextual, socioeconomic and case-level data are to be compiled from a variety of sources, and analyzed in order to document the baseline conditions and changing patterns, and to identify short-term outcomes. The researchers will: (1) use existing national data (e.g., Census, CPS, and SIPP) on American Indians to provide a context for the study of Arizona, (2) collect quarterly case- or household-level data on the welfare recipients on Indian reservations in Arizona to examine their characteristics and monitor changes in their situations under TANF, and (3) track and document TANF implementation by tribal entities using content analysis of relevant documents, in- depth telephone interviews and site visits. The evaluation of the long-term impact of the reform program is to be undertaken during the last four years of the project.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Faris, Hossein, Ph.D.
202-205-4922

PIC ID: 6832

PERFORMER: Washington University, School of Social Work
St. Louis, MO

EXPECTED DATE OF COMPLETION: 09/30/2002

Wisconsin Pay for Performance/Self-Sufficiency First Evaluation

Under the self-sufficiency first portion of this Aid to Families with Dependent Children (AFDC) demonstration, applicants for AFDC who were not exempt from Job Opportunities and Basic Skills (JOBS) had to complete 60 hours of JOBS activities prior to approval. Under the Pay for Performance portion of the demonstration, recipients were required to participate in up to 40 hours of JOBS activities per week, and for each hour the recipient did not participate, the AFDC grant and food stamp allotment was reduced by the Federal minimum wage.

AGENCY SPONSOR: Office of Planning, Research, and Evaluation

FEDERAL CONTACT: Sternbach, Leonard
415-437-7671

PIC ID: 6838

PERFORMER: Wisconsin Department of Workforce Development
Madison, WI

EXPECTED DATE OF COMPLETION: 10/30/1999

Youth Employment and Training Initiative (YETI)

The State will complete an evaluation of its Youth Employment and Training Initiative (YETI), which operated as a welfare reform demonstration from November 1993 until July 1997, when TANF was implemented in the State. YETI focused on inner-city youth in welfare families and provided counseling and classes designed to (1) help participants to stay in high- school and graduate, (2) increase life skills and self-esteem and reduce the incidence of pregnancies and substance abuse, (3) increase job-readiness and vocational skills, and (4) facilitate the transition from school to work. The overall objective of the project is to reduce the likelihood of welfare dependency among inner-city youth.

AGENCY SPONSOR: Office of Planning, Research, and Evaluation

FEDERAL CONTACT: Maniha, John
202-401-5372

PIC ID: 6821

PERFORMER: Illinois Department of Human Services
Springfield IL

EXPECTED DATE OF COMPLETION: 12/31/2000

Administration on Aging

MISSION: To foster the development of services to help older persons maintain their independence.

Evaluation Program

The Administration on Aging (AoA) is the Federal focal point and advocate agency for older persons and their concerns. The AoA administers key Federal programs mandated under various titles of the Older Americans Act. These programs help vulnerable older persons remain in their own homes by providing supportive services. Other programs offer opportunities for older Americans to enhance their health and to be active contributors to their families, communities, and the Nation through employment and volunteer programs. The AoA works closely with its nationwide network of regional offices and State and Area Agencies on Aging to plan, coordinate, and develop community-level systems of services that meet the unique needs of individual older persons and their caregivers. The AoA collaborates with Federal agencies, national organizations, and representatives of business to ensure that, whenever possible, their programs and resources are targeted to the elderly and coordinated with those of the network on aging. As the responsibilities of this nationwide network of State and Area Agencies on Aging continue to grow, it is essential that they have the necessary information to meet these responsibilities.

The overall evaluation priorities of the AoA are to support studies that provide information on the following: (1) the success of existing program implementation in meeting the goals of the Older Americans Act; (2) the design and operation of effective programs; and (3) issues relevant to policy development, legislative planning, and program management.

In-Progress Evaluations

Alzheimer Disease Demonstrations

Alzheimer's Disease Demonstration Grants to States Program Evaluation

This contract provides for a statutorily mandated programmatic evaluation of the Alzheimer's Disease Demonstration Grants to States program, which was transferred to AoA from HRSA in November 1998. Included in this contract is data collection and management, and program evaluation of the 15 Demonstration sites nationwide. This contract is intended to support the continuation of data collection and monitoring for accuracy, completeness and quality, the collection of all program data from the 15 ADDGS grantees for a period of 20 months, and the dissemination of program data and information at national professional conferences. Contract includes the provision of a final report on the program.

AGENCY SPONSOR: Office of Assistant Secretary for Aging

FEDERAL CONTACT: Starns, Melanie K.
202-401-4547

PIC ID: 7296

PERFORMER: University of Kansas
Topeka KS

EXPECTED DATE OF COMPLETION: 6/30/2000

Alzheimer's Disease Demonstration Grants to States Program: Further Evaluation and Data Analysis

The purpose of this contract is to analyze the longitudinal data collected for the past seven years through the Alzheimer's Disease Demonstration Grants to States program and to produce a written report of that analysis for use in reporting to Congress on some of the outcomes of the ADDGS Program.

AGENCY SPONSOR: Office of Assistant Secretary for Aging

FEDERAL CONTACT: Starns, Melanie K.
202-401-4547

PIC ID: 7297

PERFORMER: University of Kansas
Topeka KS

EXPECTED DATE OF COMPLETION: 12/31/2000

Alzheimer's Disease Demonstration Grants to States Program: Managed Care Initiative

The purpose of the ADDGS Managed Care Initiative, initiated by HRSA in 1997 (when they were administering this program) is to test the effect of community-based interventions for persons with Alzheimer's disease and their families upon use of primary care physicians in a managed care setting. Final analysis will seek to determine if there is a decreased utilization of primary care physicians for resource and referral purposes and if there is any discernable difference between families participating in the program and those accessing information through routine channels.

AGENCY SPONSOR: Office of Assistant Secretary for Aging

FEDERAL CONTACT: Starns, Melanie K.
202-401-4547

PIC ID: 7298

PERFORMER: University of Kansas
Topeka KS

EXPECTED DATE OF COMPLETION: 7/1/2003

Support Services to Elderly Persons

Performance Outcome Measures Project: Field Testing Phase

The Performance Outcomes Measures project (POMP) has been sponsored by the Administration on Aging (AoA) to develop performance based measures for evaluating aging services. Another goal is to develop a prototype system for recording and reporting agency level information. POMP is a multi-agency collaboration involving state and local agencies on aging. AoA, contractors and consultants. The performance measures developed for this project are intended to cover a range of issues such as: documenting that services are targeted to persons with the greatest social and economic needs, as the Older Americans Act requires; identifying, exploring, or monitoring important aspects of the services provided or the communities and client populations served by programs, even where no clear link to services can be established and analyzing the accomplishments of programs or services for service recipients. AoA has recently made grants to sixteen states for a second year of field testing of the survey instruments developed during the first year of the project. Preliminary data from the first project year are now beginning to arrive and to be analyzed with an eye toward program improvements.

AGENCY SPONSOR: Office of Assistant Secretary for Aging

FEDERAL CONTACT: Bunoski, David
202-260-0669

PIC ID: 6855

PERFORMER: Westat, Inc.
Rockville, MD

EXPECTED DATE OF COMPLETION: 2/1/2001

Agency for Healthcare Research and Quality

MISSION: To generate and disseminate information that improves the health care system.

Evaluation Program

The Evaluation Program within the Agency for Healthcare Research and Quality (AHRQ) provides information on the Agency's effectiveness in meeting its long-term goals and priorities, the efficiency of the Agency's program performance through internal evaluations, and critical Agency and departmental concerns via "fast-track" or quick-turnaround assessments.

Evaluation components are built into virtually all major AHRQ programmatic activities and a wide variety of "freestanding" projects are undertaken as needs are identified. Among the evaluation mechanisms used by the Agency are targeted evaluation studies undertaken through contracts or grants; efforts to obtain feedback from "customers" on the usefulness of AHRQ research efforts, including such mechanisms as focus groups and surveys; and feedback from AHRQ's User Liaison program (which provides information and technical assistance to State policymakers, health departments, and officials). Information gathered from AHRQ's evaluation-related activities are used in the annual performance plans developed in response to the Government Performance and Results Act starting in FY 1999.

All "freestanding" evaluation activities undergo two levels of review. First, brief evaluation proposals are developed by staff and undergo review by senior managers. Those proposals approved by senior managers are submitted for review by the director. The director evaluates proposals for policy relevance, priority, cost effectiveness, and timeliness. Those that receive the approval of the director are then methodologically developed and centrally reviewed for technical merit, including technical feasibility, costs, and relation to ongoing evaluation activities.

Fiscal Year 1999 Evaluation Reports

Cross-Cutting

Evaluation of Streamlining Procedures for AHQR Grant Application Submission and Review: Final Report

This study evaluated a series of initiatives put in place by the agency to streamline its grant application submission and review processes. The initiatives were intended to make the submission and review of grant applications more efficient and effective, from both the Agency's perspective and that of its applicants. The study identified advantages and limitations associated with the various streamlining initiatives. In addition, the study sought to identify key issues that should be covered by an ongoing feedback system to assess how well initiatives are working as well as to explore options to gather data to address these information needs.

AGENCY SPONSOR: Center for Cost and Financing Studies

FEDERAL CONTACT: Hurley, Joan
301-594-6075

PIC ID: 7400

PERFORMER: Research Triangle Park
Research Park, NC

Outcomes and Effectiveness

The Outcome of Outcomes Research at AHCPR

Intended for use in ongoing discussions of strategic directions for the outcomes research program, this report covers three main topics: (1) a conceptual framework for understanding and communicating the impact of outcomes and effectiveness research (OER) on health care practice and outcomes; (2) a critical analysis of accomplishments and lessons learned over the past decade; and (3) a list of recommendations intended to maintain AHCPR strengths while increasing the measurable impact of future research. The primary questions examined by this analysis are, "How can the outcomes and effectiveness program at AHCPR most effectively advance the field of Health Services Research (HSR), fulfill its unique role in HSR, contribute to improved public health, and address the expectations of policymakers and stakeholders?" "The Outcome of Outcomes Research at AHCPR" is a first step to redefining the goals of OER, as well as an honest appraisal of prior successes and opportunities for improvement.

AGENCY SPONSOR: Center for Outcomes and Effectiveness Research

FEDERAL CONTACT: Clancy, Carolyn M.
301-594-1485

PIC ID: 5979

PERFORMER: Lewin Group
San Francisco, CA

Quality Measurement

Inventory of the DHHS Performance Measures -- Phase III Data Collection and Analysis

In January 1997, the Agency for Health Care Policy and Research (AHCPR) contracted with the Center for Health Policy Studies (CHPS) to create an inventory of clinical, population, and system performance measures for the purposes of identifying gaps and overlaps in measures and to better enable coordinated development and implementation of them. The project was implemented in phases. Phase I was the creation of a workplan, and Phase II was devoted to development and testing of data collection instruments and software capable of displaying the information in a user-friendly way. In Phase III, CHPS collected, catalogued, and put into a database, performance measures from a number of agencies including the Coast Guard, Department of Defense, Department of Veterans Affairs, Federal Bureau of Prisons, Health Care Financing Administration, Health Resources and Services Administration, Indian Health Service, and the Substance Abuse and Mental Health Services Administration. The Performance Measures Inventory includes 1,430 measures. It will be distributed to the Measures Workgroup of the Quality Interagency Coordinating Committee (QuIC), the group most expected to use the inventory. They will use the inventory to begin to help identify gaps and overlaps in measures and promote a better coordinated approach to measures development and implementation within the Federal government. (See PIC ID 6691 and 6691.1)

AGENCY SPONSOR: Center for Quality Measurement and Improvement

FEDERAL CONTACT: Keyes, Marge
301-594-1824

PIC ID: 6691.2

PERFORMER: Center for Health Policy Studies
Columbia, MD

In-Progress Evaluations

Cross-Cutting

Evaluation of Data Sources Used in Research on Health Care Markets

This project will produce an inventory, identify characteristics, and initiate an evaluation of the data sources that have been used to measure competition and market structure in AHRQ-supported research grants and other projects examining the role that market forces play in the organization and delivery of health care--in order to answer key questions, such as: What data sources have been used for such purposes? How has such data been used? What other data sources are comparable? What are the strengths and weaknesses of such data used for such research purposes?

AGENCY SPONSOR: Agency for Healthcare Research and Quality

FEDERAL CONTACT: Hagan, Michael
301-594-1354

PIC ID: 7402

PERFORMER: Center for Health Policy Research
Denver, CO

EXPECTED DATE OF COMPLETION: 10/31/2000

Evaluation of Outreach for Public Health Insurance and Selected Other Programs

This effort was comprised of a literature review and synthesis of the empirically-based evidence on the effectiveness of interventions to increase enrollment of low-income children and families in public health insurance programs. The primary purpose of the literature review was to enhance understanding of what is known, and what is yet to be known, about the types of outreach interventions that are likely to be most successful for increasing enrollment in state SCHIP and Medicaid programs.

AGENCY SPONSOR: Center for Cost and Financing Studies

FEDERAL CONTACT: Peggy McNamara
301-594-6826

PIC ID: 7399

PERFORMER: Barents Group, KPMG Peat Marwick LLP
Washington, DC

EXPECTED DATE OF COMPLETION: 03/15/2000

Feasibility Study for Electronic Bulletin Board (EBB) to Promote Health Services Research Partnerships

This study will: (1) explore the feasibility of an electronic bulletin board (EBB) to promote partnerships among health services researchers, and between health services researchers and health care organizations, associations, or individuals with databases or health care settings that might be useful for research purposes; (2) design an EBB, should it prove feasible, including recommendations for monitoring; and if implemented, (3) develop a plan to promote the EBB during its first six months of operations.

AGENCY SPONSOR: Agency for Healthcare Research and Quality

FEDERAL CONTACT: Brach, Cindy
301-594-1824

PIC ID: 7404

PERFORMER: Battelle Corporation
Arlington, VA

EXPECTED DATE OF COMPLETION: 07/10/2000

Health Services Research Education: Assessing Customer Satisfaction and Program Needs

This is an evaluation of certain elements of a national training program in health services research funded by the Agency for Healthcare Research and Quality (AHRQ). The project will provide AHRQ with information about present and anticipated needs in health services research training and an assessment of the level of satisfaction that past trainees from the institutionally based training programs have had with their experiences during training, and with the adequacy of these training activities relative to trainees' career expectations and requirements.

AGENCY SPONSOR: Center for Cost and Financing Studies

FEDERAL CONTACT:Rothstein, Debbie
301-594-2918

PIC ID: 7397

PERFORMER: Battelle Corporation
Arlington, VA

EXPECTED DATE OF COMPLETION: 12/31/1999

Evidence-Based Medicine

Development and Implementation of Evidence-Based Practice Center (EPC) Program Evaluation

The Agency for Health Care Policy and Research (AHCPR) supports 12 Evidence-based Practice Centers (EPCs) to undertake scientific analyses and evidence syntheses on high-priority topics. The science syntheses-evidence reports and technology assessments produced by the EPCs provide the scientific foundation for public and private organizations to use in developing and implementing their own practice guidelines, performance measures and other tools to improve the quality of health care and make decisions related to the effectiveness or appropriateness of specific health care technologies.

AGENCY SPONSOR: Center for Practice and Technology Assessment

FEDERAL CONTACT: Coopey, Margaret
301-594-4022

PIC ID: 7037

PERFORMER: Medstat Group
Washington, DC

EXPECTED DATE OF COMPLETION: 06/02/2000

Empirical Analysis of a Guideline-developed Clinical Performance Measure

Assessing and categorizing whether actual care conforms to clinical practice guidelines is an increasingly common approach to measuring appropriateness and quality of health services. Often, however, the process of care that is to be categorized simply as conforming or not may involve several different components or dimensions. This project will analyze existing data concerning one example of such a summary measure, conformance with American Academy of Pediatrics recommendations regarding gastroenteritis, for the purpose of evaluating the extent to which the overall measurements of whether practices conform may be sensitive to choices between alternative approaches for assessing the different components or dimensions of care.

AGENCY SPONSOR: Agency for Healthcare Research and Quality

FEDERAL CONTACT: Fox, Steve, M.D.
301-597-1485

PIC ID: 7403

PERFORMER: Medstat Group
Washington, DC

EXPECTED DATE OF COMPLETION: 12/29/2000

Evaluation of the National Guideline Clearinghouse

The National Guideline Clearinghouse (NGC) is a web-based source of clinical practice guidelines. Guidelines are available in both abstract and full-text with links to original sources. Guidelines can be downloaded in various formats and mechanisms. It offers comparisons of guidelines that cover similar topic areas, with major interventions and areas of agreement and disagreement. A structured program evaluation will be completed on the National Guideline Clearinghouse to look at what works and doesn't work and how it can be improved. The evaluation will: (1) identify and survey the intended NGC users to understand the quality and usefulness of NGC products, and how the information is being applied to health care delivery; (2) identify and survey the intended users who have not yet accessed the NGC to determine why they are not using the site; (3) evaluate the website functionality, content and linkages to identify opportunities to improve the products and services; and (4) provide a limited assessment of the impact of the NGC on the development of guidelines and quality improvement initiatives to affect clinical behavior.

AGENCY SPONSOR: Center for Practice and Technology Assessment

FEDERAL CONTACT: Coopey, Margaret
301-594-4022

PIC ID: 5955

PERFORMER: Lewin Group
San Francisco, CA

EXPECTED DATE OF COMPLETION: 03/15/2001

Medical Expenditure Panel Survey

Evaluation of Performance of the Medical Expenditure Panel Survey (MEPS)

The purpose of the project is to evaluate key aspects of the MEPS in terms of data quality, cost, and timeliness. The evaluation will focus on areas in which there have been programmatic concern, especially those in which the data now exist for evaluation and which would be implemented in a timely way to inform quality enhancements for MEPS. Where appropriate, the evaluation will identify priorities for redesign, and outline potential cost-effective alternatives.

AGENCY SPONSOR: Agency for Healthcare Research and Quality

FEDERAL CONTACT: Hagan, Michael
301-594-1354

PIC ID: 7401

PERFORMER: Research Triangle Institute
Research Triangle Park, NC

EXPECTED DATE OF COMPLETION: 09/29/2000

Quality Measurement

CONQUEST Evaluation

The Computerized Needs Oriented Quality Measurement Evaluation System (CONQUEST) is a quality improvement software tool that provides information on 1,200 clinical performance measures, both process and outcomes, on more than 50 conditions. This project will: (1) design an evaluation for CONQUEST 2.0; (2) design an evaluation for a future procurement that builds upon CONQUEST 2.0 which will become a part of the RFP for that future product; and (3) implement an evaluation of CONQUEST 2.0. In addition, information will be gathered on recommendations for improvement in the tool to better meet the needs of its users.

AGENCY SPONSOR: Center for Quality Measurement and Improvement

FEDERAL CONTACT:Keyes, Marge
301-594-1824

PIC ID: 7010

PERFORMER: Research Triangle Park
Research Triangle Park, NC

EXPECTED DATE OF COMPLETION: 06/07/2000

Agency for Toxic Substances and Disease Registry

MISSION: To prevent exposure and adverse human health effects and diminished quality of life associated with exposure to hazardous substances from waste sites, unplanned releases, and other sources of pollution present in the environment.

Evaluation Program

The Agency for Toxic Substances and Disease Registry (ATSDR) was created as a Federal agency by the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA), more commonly known as Superfund. ATSDR was created to implement the health-related sections of CERCLA and other laws that protect the public from hazardous waste and environmental spills of hazardous substances. The ATSDR evaluation program is coordinated with the agencywide strategic planning process to implement requirements of the Government Performance and Results Act (GPRA). ATSDR's strategic goals and its annual performance plan are the result of an interactive process that reflects a long-term commitment by Agency staff to develop stronger relationships among external clients and stakeholders, to assess products and services using relevant data, and to improve our processes and systems for more efficient accomplishment of ATSDR's mission.

There are four strategic questions important to the Agency. How should ATSDR evaluate the public health needs of its stakeholders and involve those stakeholders in the Agency's program planning, implementation, and evaluation? How should ATSDR's roles in assessment, science, health promotion, and service be implemented to meet the needs of its stakeholders and to achieve its mission? How does ATSDR ensure that it has the authorities and resources necessary to address the public health needs of its stakeholders? And finally, how should ATSDR evaluate the public health impact of its products and services?

Fiscal Year 1999 Evaluation Reports

Emergency Events Surveillance

ATSDR HazDat System Evaluation Project

This evaluation consisted of a high level review of the Agency for Toxic Substances and Disease Registry (ATSDR) business processes supported by HazDat. The business process review included the identification of what management considered core business functions and processes and a survey of HazDat user functionality requirements. The HazDat current value to agency programs was assessed and the systems strengths and limitations identified. System improvement concepts were delineated and the potential future HazDat value assessed. Complementing the business assessment, a high level review of the current HazDat architecture and system development activities was completed. Interviews were conducted with ATSDR system support staff, contractors and vendors. The study culminated in a series of recommendations for future enhancements and improvements directed at providing added value to the user community.

AGENCY SPONSOR: Agency for Toxic Substances and Disease Registry

FEDERAL CONTACT: Perry, Mike
404-639-0720

PIC ID: 7243

PERFORMER: Agency for Toxic Substances and Disease Registry
Atlanta, GA

Hazardous Substances Emergency Events Surveillance (HSEES): Annual Report 1998

The Hazardous Substances Emergency Events Surveillance (HSEES) system is an active, state-based surveillance system with the goal of reducing the public health consequences associated with the release of hazardous substances. Thirteen state health departments participated in the final year 1998-1999 of the five year cooperative agreement. The 13 states reported a total of 5987 events for 1998. The most commonly reported categories of substances were volatile organic compounds; other inorganic substances; a category designated "other," which includes substances that could be placed in one of the other 10 categories. During this reporting period, 405 events resulted in a total of 1533 victims. The most frequently reported injuries sustained by victims were respiratory irritation, eye irritation, skin irritation, gastrointestinal problems, and headache. A total of 36 persons died as a result of all events, and 537 events required evacuations. Each of the 13 states has produced a final cumulative report for the cooperative agreement period. These reports are currently undergoing review and will be available shortly. The states have taken data from their cumulative reports to develop prevention outreach plans which they will begin implementing in the 1999-2000 year.

AGENCY SPONSOR: Agency for Toxic Substances and Disease Registry

FEDERAL CONTACT: Orr, Maureen
404-639-6391

PIC ID: 6854.1

PERFORMER: Agency for Toxic Substances and Disease Registry
Atlanta, GA

In-Progress Evaluations

Emergency Events Surveillance

Hazardous Substances Emergency Events Surveillance (HSEES)

The Hazardous Substances Emergency Events Surveillance (HSEES) Evaluation Report, generated annually, discusses the evaluations conducted for the surveillance of hazardous events and system reporting. The evaluation is based on the ability to measure the sensitivity and reliability of the system. Sensitivity is measured by the ability of the system to receive notification of events involving hazardous substances meeting the HSEES case definition, evaluated by comparison to other national data collection systems (i.e., DOT, EPA). Reliability is measured by the ability of the system to receive uniformly recorded data from the 13 State health department partners. To address the reliability of HSEES, each quarter the ATSDR mails a report describing a case study involving the release or threatened release of a hazardous substance or substances to participating State health departments. State health department partners review the case study and completes a hard copy data collection form which is returned to the ATSDR. The ATSDR then compares the responses on these forms to each other and to the ATSDR's preferred responses.

AGENCY SPONSOR: Agency for Toxic Substances and Disease Registry

FEDERAL CONTACT: Orr, Maureen
404-639-6391

PIC ID: 6854.2

PERFORMER: Agency for Toxic Substances and Disease Registry
Atlanta, GA

EXPECTED DATE OF COMPLETION: 6/30/2001

Centers for Disease Control and Prevention

MISSION: To promote health and quality of life by preventing and controlling disease, injury, and disability.

Evaluation Program

The Centers for Disease Control and Prevention (CDC) conducts evaluation studies designed to provide information essential for CDC's 11 strategies to achieve its mission:

  • Conduct public health research, including epidemiology, laboratory, behavior, and social sciences.
  • Develop and implement ongoing evaluation of scientific research.
  • Assure that scientific information is communicated effectively to the general public.
  • Develop and implement public health information systems for monitoring and promoting the health of the Nation.
  • Deploy multidisciplinary teams to detect and investigate health threats.
  • Develop and implement a system for establishing CDC scientific and programmatic priorities.
  • Routinely evaluate the effectiveness and cost of CDC programs.
  • Demonstrate the value of investment in health prevention.
  • Collaborate with diverse partners.
  • Design, implement, and evaluate prevention programs based on community needs.
  • Prepare the public health leaders (present and future) through training in management and public health science.

CDC places high priority on evaluations to answer policy, program, and strategic planning questions related to the goals and objectives of Healthy People 2000. Performance improvement studies, such as those focusing upon the development of indicators consistent with the Government Performance and Results Act (GPRA), are of particular interest and import to the Agency. With the support of 1-percent evaluation funds, the GPRA planning process began at CDC in FY 1995 and is continuing. CDC's commitment to performance measurement is exemplified by this year's requirement that each project proposal be linked to one of CDC's strategic goals. These goals were identified through the GPRA strategic planning process.

Fiscal Year 1999 Evaluation Reports

Chronic Disease

Development, Assessment, and Implementation of an Evaluation for CDC's National Program of Cancer Registries

As part of a national disease prevention strategy, the Center for Disease Control's (CDC's) National Program of Cancer Registries (NPCR) provides funding to establish or enhance state and territorial central registries to reduce cancer mortality. The purpose of this study was to review and revise the evaluation tools used to assess NPCR's progress toward meeting its goals and objectives. An important recommendation was to develop a World Wide Web-based survey system for collecting evaluation data from the registries, and the CDC is already moving forward with this plan. The data collected for this system will receive greater emphasis in achieving cancer control objectives through additional monitoring and financial support of the cancer registries.

AGENCY SPONSOR: National Center for Chronic Disease Prevention and Health Promotion

FEDERAL CONTACT: Simpson, Leah
770-488-4158

PIC ID: 7050

PERFORMER: Battelle Corporation
Arlington, VA

Evaluation of Encarguese De Su Diabetes: Una Guia Para Su Cuidado

The purpose of this guide was to provide information to Hispanics with diabetes who use public sector health services on how to take care of and control their disease. After the preliminary edition of the guide was produced, the Division of Diabetes Translation (DDT) sought to evaluate its understandability, relevance, usefulness and adaptability among diverse U.S. Hispanic populations. The objectives of this study were to identify the types of health information needed for enhancing the day-to-day management of diabetes and to determine additional appropriate methods for communicating information on diabetes self-care. A total of twenty focus groups were held in five locations among Hispanic populations representing Mexican Americans, Central Americans, South Americans, Cuban Americans and Puerto Ricans. A topic guide was developed as a tool to elicit participant perspectives about the guide and additional methods for communicating and disseminating diabetes information. The first phase evaluated the preliminary guide produced by the Centers for Disease Control and Prevention (CDC). The second phase evaluated the revised guide based on the suggested and approved changes and additions made by participants in the first phase, and concentrated on eliciting perspectives on additional methods for communicating information on diabetes self-care. A video concept paper and video script were developed based on information obtained during the focus group discussions. (Note: The final product, "Take Control of Your Diabetes," is available in the PIC Center in both Spanish and English. Or, they can downloaded from the DHHS/CDC web site).

AGENCY SPONSOR: National Center for Chronic Disease Prevention and Health Promotion

FEDERAL CONTACT: Mitchell, Patricia
770-488-5015

PIC ID: 5352

PERFORMER: Casals and Associates
Arlington, VA

Evaluation of the Use of the Code "Probably Benign--Short Term Follow-Up Suggested" to Classify Mammograms

Many breast lesions detected by mammography show features that indicate that they have a high, but not absolute, likelihood of being benign. The American College of Radiology Breast Imaging Reporting and Data System Classification includes "probably benign finding--short interval follow-up suggested" for use in this circumstance. CDC has determined that the use of this code varies across States enrolled in the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), a program designed to provide breast and cervical cancer screening and follow-up services to low-income, uninsured women through State health departments. To understand the factors affecting the use of this classification by radiologists, CDC conducted a national survey of these radiologists. The purpose of this study was to understand the range of factors which may impact the use of this code. A series of focus groups of radiologists were conducted in order to determine these factors. Covered in the report are data concerning the background of the radiologist, patient-related factors, practice-related factors, factors external to the clinical setting, and direct information on understanding and use of this code.

AGENCY SPONSOR: National Center for Chronic Disease Prevention and Health Promotion

FEDERAL CONTACT: Caplan, Lee

PIC ID: 7065

PERFORMER: Battelle Corporation
Arlington, VA

Final Report for the Evaluation of the CDC-Supported Technical Assistance Network for Community Planning: Vol. I, Technical Report; Vol. II, Appendices

The purpose of this study was to evaluate for the Centers for Disease Control the HIV/AIDS Technical Assistance Network to: 1) demonstrate the success of the network; 2) recommend ways of strengthening the network; and to 3) develop a design for future evaluations of the TA Network. The methodology consisted of: 1) a process evaluation that involved nine TA partners who were in the TA Network at the time of the evaluation. This process evaluation took the form of face-to-face and telephone discussions and document reviews; and 2) an effectiveness evaluation which consisted of eight case studies of successful TA "experiences." The final report provides a rich description of the TA Network and a list of 12 recommendations for strengthening the TA Network and the community planning process as a whole. Among other things, the TA Network could improve its coordination and establish an identify for itself through logos and common outreach materials. In addition, the TA Network could provide common training and orientation opportunities for TA-providing organizations or among individual TA consultants to ensure consistency throughout the TA Network. [Two volume Final Report: Vol. I, Technical Report; Vol. II, Appendices].

AGENCY SPONSOR: National Center for Chronic Disease Prevention and Health Promotion

FEDERAL CONTACT: Barrington, Tracey
404-639-0953

PIC ID: 6706

PERFORMER: Battelle Corporation
Arlington, VA

Public Health Education Needs for CDC's National Skin Cancer Prevention Education Program

The purpose of this study was to determine parental knowledge, attitudes and behaviors regarding skin cancer prevention for children in a representative sample of the U.S. population. Skin cancer is the most common form of cancer in the United States, with an annual incidence of 700,000 cases and a mortality rate of 9,000 people each year. Major risk factors for skin cancer are skin sensitivity and exposure to ultraviolet radiation. Although the effects of sun exposure are typically not seen until later in life, 50 percent to 80 percent of total lifetime sun exposure occurs before the age of 18 and the average child receives three times the annual exposure of adults. While current estimates suggest that sun protection behaviors are practiced by about half of white American adults, limited research has been done regarding sun protection behaviors of parents for their children. The results of the study are used for two purposes. First, they provide baseline data on knowledge, attitudes and behaviors so that CDC's National Skin Cancer Prevention and Education Program can measure changes over time. Second, they are used to develop effective health education messages as part of the program. A survey was administered over the phone to a nationally representative sample of parents of children aged between six months and eleven years old. A Computer Assisted Telephone Interview (CATI) System was used, and the survey sampling plan targeted households using a dual frame approach. A total of 22,626 phone numbers were included in the survey sample. 13, 675 households were contacted, and of that number, 1, 286 successfully completed the interview.

AGENCY SPONSOR: National Center for Chronic Disease Prevention and Health Promotion

FEDERAL CONTACT: Hall, Irene
770-488-3001

PIC ID: 7066

PERFORMER: Battelle
Durham, NC

Cross-Cutting

The Future of OPPE and the OPPE of the Future: OPPE Strategic Planning Pilot

This study was conducted to improve the functioning of the Office of Program Planning and Evaluation (OPPE) within the Centers for Disease Control so that it might better respond to the requirements of the Government Performance and Results Act (GPRA) as well as to the needs of the agency. After conducting strategic planning and organizational assessments, a plan of goal-oriented action was reached. Recommendations included: improving both internal and external communication and developing data capacity in support of finding solutions. To improve decisionmaking, recommendations included designating a senior staff to work as a team in support of new projects, developing a timely and effective way to keep the director aware of important issues requiring the attention of senior management, and creating a more fluid organizational structure which would allow a flexible response to unpredictable events as well as a reliable response to predictable events, increasing reliance on a team approach to accomplish goals. Emphasis should be placed on involving leadership to direct tangible actions to accomplish underlying change.

AGENCY SPONSOR: Office of Program Planning and Evaluation

FEDERAL CONTACT: Carmack, Connie
404-639-7073

PIC ID: 7049

PERFORMER: Macro International, Inc.
Atlanta, GA

Environmental Health

Evaluation of Implementation of New CDC Guidelines on Screening Lead Poisoning

CDC revised its lead screening recommendations in a document published in November 1997: Screening Young Children for Lead Poisoning: Guidance for State and Local Health Officials. The revisions reflected the need to improve the effectiveness of screening as a preventive measure by calling on state and local health officials to develop statewide plans and follow-up care appropriate to local conditions. This study monitored the state planning process, identified states which had made significant progress and how they had managed to do so, and disseminated the information to other states. Central to the study was an examination of state advisory committees: their membership and how they function. The study found that while the committees functioned in a complicated way and were time-consuming, the alternative, making decisions without the involvement of these stakeholders, is a less effective way to build a consensus on lead screening.

AGENCY SPONSOR: National Center for Chronic Disease Prevention and Health Promotion

FEDERAL CONTACT: Tips, Nancy
770-488-7277

PIC ID: 7045

PERFORMER: Macro International, Inc.
Calverton, MD

Evaluation of State Water Fluoridation Programs Needs to Improve the Quality of Water Fluoridation

The purpose of this task was to evaluate the needs of state water fluoridation programs in order to improve the quality of water fluoridation, nationally. The task assessed the surveillance and monitoring of water fluoridation system, the engineering and administrative aspects of same, and the fluoridation training needs of nine states. Each of these elements were examined for a determination of their effect on the quality of water fluoridation in those states. The majority of respondents indicated that each state had an organized fluoridation program, including fluoridation specialists. Turnover, at the local water system level, is of concern to a significant number of respondents. The majority of respondents indicated that their monitoring and surveillance component of their state fluoridation system is being adequately met. Minimum CDC guidelines are not being met in some states. Training needs were consistently indicated as the greatest need from among respondents in the three groups. Most respondents indicated they would likely use the Fluoridation Reporting System (FRS). The report provides the basis for making recommendations to improve and ensure the quality of state fluoridation programs in the United States. The recommendations from this report are grouped into four areas: infrastructure, monitoring and reporting, training and overall program needs. The results will help determine the future direction of the Division of Oral Health (DOH) in its national role of promoting community water fluoridation.

AGENCY SPONSOR: National Center for Chronic Disease Prevention and Health Promotion

FEDERAL CONTACT: Shaddix, Kit
770-488-6074

PIC ID: 7052

PERFORMER: Macro International, Inc.
Atlanta, GA

Epidemiology

Varicella Surveillance: Current Status and Future Directions

The purpose of this project was to prepare a summary of proceedings and recommendations of a CDC meeting convened by the National Immunization Program, Centers for Disease Control and Prevention to consider requirements for national surveillance of varicella and zoster. The meeting was held in Atlanta on March 12-13, 1998. Representatives of organizations concerned with surveillance of vaccine-preventable diseases (including NIP, the National Center for Infectious Diseases (NCID), the Council of State and Territorial Epidemiologists (CSTE), immunization program managers, the vaccine manufacturer, and academic scientists), met to: discuss the current status of varicella surveillance in the United States; determine the epidemiologic and laboratory capacities required for effective surveillance at the state and national levels; and review proposed immunization coverage and disease reduction goals for varicella.

AGENCY SPONSOR: Office of Program Planning and Evaluation

FEDERAL CONTACT: Chalmers, Nancy
404-639-7085

PIC ID: 7293

PERFORMER: Battelle Memorial Institute, Centers for Public Health Research
and Evaluation, Rockville, MD

HIV/STD/TB Prevention

An Assessment to Determine Program Evaluation Technical Assistance Needs for HIV Prevention

The intent of this study was to provide the Centers for Disease Control and Prevention's (CDC's) Division of HIV/AIDS Prevention with information to more effectively address the needs, wants, resources and preferences related to program evaluation technical assistance (TA). Three independent areas of inquiry were identified: (1) understanding beliefs and attitudes about evaluation that are likely to affect evaluation TA use; (2) assessing needs for evaluation TA and preferences for its delivery; and (3) describing existing evaluation TA resources and delivery systems. Relevant, recent documents and studies were reviewed, CDC staff were interviewed, and individuals from 55 indirectly funded and six directly funded community based organizations (CBOs) were interviewed. Based upon the study's findings, recommendations were made in the following areas: (1) supporting factors and conditions; (2) TA content; and (3) TA format or system.

AGENCY SPONSOR: Office of Program Planning and Evaluation

FEDERAL CONTACT: Cheal, Nancy
404-639-7095

PIC ID: 6715

PERFORMER: Research Triangle Institute and MEDSTAT Group
Research Park, NC and Washington, DC

Case Studies of the PMI Local Demonstration Site Projects: Experiences During Transition and Implementation

In 1993, the Office of HIV/AIDS of the Centers for Disease Control and Prevention (CDC) inaugurated a demonstration of social marketing entitled the Prevention Marketing Initiative (PMI). PMI melded social marketing techniques with elements of behavioral science and community participation, a synthesis conveyed by the term "prevention marketing." Initially, the scope of PMI was both national and local, with three major components: (1) national health communications; (2) prevention collaborative partners; and (3) local demonstration sites. This study is concerned with the third of these components. The purpose of this case study is to describe the experiences of the project participants during the latter phases of the project, both at the local and national levels, and to provide lessons learned from these experiences that can inform future prevention marketing initiatives. This information will also be used to provide context for the other evaluation efforts being conducted for PMI. These include evaluations of the outcomes of site-based skills-building workshops, and the community-wide level of exposure to media messages. The case study had two major objectives: (1) describe changes in organizational structures and processes that have occurred since the first case study was completed in 1996; and (2) document experiences within the major components of PMI during the past two years. These components include: (1) social marketing; (2) community collaboration (including media relations); (3) behavioral science; (4) youth participation; (5) technical assistance; (6) intervention implementation; (7) sustainability planning; and (8) implementation of the sustainability plan. (See also 6337)

AGENCY SPONSOR: Office of Program Planning and Evaluation

FEDERAL CONTACT: Cheal, Nancy
404-639-7095

PIC ID: 6337.1

PERFORMER: Battelle
Durham, NC

Community Indicators Project: Final Report

The community indicators project was created to identify community characteristics that influence risk behavior and could be measured and changed in a community-level HIV/AIDS intervention research trial. The goal was to develop a model for prioritizing community characteristics to be changed as well as suggesting causal mechanisms linking them to behavior and sustainability of interventions. A panel of 24 experts surveyed identified a total of 2,454 potential community indicators relevant to HIV intervention research activities; a literature search was conducted for the same purpose; and a meeting was held of researchers, government scientists, and other "end users" of indicators to obtain their contribution to help refine a working model and to develop methods that could be used to elicit and evaluate potential community indicators.

AGENCY SPONSOR: National Center for HIV, STD, and TB Prevention

FEDERAL CONTACT: Sumartojo, Esther
404-639-8300

PIC ID: 6278

PERFORMER: Macro International, Inc.
Atlanta, GA

Evaluating Guidelines for Preventing Perinatal HIV

This project developed, piloted, and conducted a survey and produced technical reports of survey data on the knowledge, attitudes, and practices of health care providers serving pregnant women regarding HIV counseling and testing and use of Zidovudine (ZDV) during pregnancy. These data augments ongoing research efforts to reduce barriers to implementation of the U.S. Public Health Service (PHS) guidelines for the prevention of perinatal HIV transmission. The target population for the survey was nurse-midwives and physicians (obstetricians and family physicians, including residents) who provide prenatal care in the state of Connecticut; the borough of Brooklyn, New York; the state of North Carolina; and Dade County, Florida. These four areas have institutions that are currently conducting a CDC-funded study of the implementation of the PHS perinatal transmission guidelines and the study areas which allowed for comparison of the survey results.

AGENCY SPONSOR: National Center for HIV, STD, and TB Prevention

FEDERAL CONTACT: Saul, Janet
404-639-6143

PIC ID: 6279

PERFORMER: Analytical Sciences, Inc.
Durham, NC

Immunization

Rapid Assessment of Influenza Vaccination in the United States

Vaccination represents the most important preventive measure available against influenza, a major cause of morbidity and mortality, especially in the elderly and persons with underlying health problems. Recommendations for influenza vaccine, as for all vaccines, must balance associated risks and benefits. In December 1990, two cases of Guillain-Barre Syndrome (GBS) within six weeks of influenza vaccination were reported in a Colorado Health Maintenance Organization (HMO). In response to these reports, active surveillance for GBS cases after influenza vaccine was undertaken to determine if there was an association between GBS and influenza vaccine. Early studies found no clear association. During the flu seasons of 1992-93 and 1993-94 over 35 and 48 cases, respectively, were reported of GBS after influenza vaccination to the Vaccine Adverse Event Reporting System (VAERS); these represented the highest totals reported for any flu season since 1976. However, the total number of vaccinations administered during the 1992-94 flu seasons were at the highest level since the swine flu vaccine program. Thus, the increased reports to VAERS may be attributed either to an increase in coincidental cases or to the vaccine itself. If the failure to detect a true association in the past was due to inadequate exposure, the large number of vaccinations administered during these two seasons represented the best opportunity to study the issue. For this study, a 49-item telephone survey indicated that: (1) nationally, approximately 26 percent of the respondents had received an influenza vaccination during the 1993-94 flu season; (2) respondents with an underlying health condition (heart, respiratory, circulatory, immunosupression) were significantly more likely to have received an influenza vaccination; and (3) nationally, 89.6 percent of respondents correctly recalled their vaccination status within the same flu season.

AGENCY SPONSOR: National Vaccine Program Office

FEDERAL CONTACT: Chen, Robert
301-402-3497

PIC ID: 5894

PERFORMER: Macro International, Inc.
Atlanta, GA

Injury/Violence Prevention

An Evaluation of the Feasability of an Injury Risk Factor Surveillance System

Injuries are a major cause of premature death and disability, with associated economic costs in 1985 of over $150 billion. Although health objectives for the Year 2000 call for reducing this toll, adequate surveillance systems have yet to be developed that can monitor the country's progress on many of the Year 2000 injury objectives. This study addressed the question as to whether a telephone survey is a feasible means of accomplishing this. The evaluation objective of this study was to evaluate the feasibility of a national telephone survey as: (1) a surveillance system for injury risk factors, (2) a means through which to monitor progress towards Year 2000 injury objectives, and (3) a tool for evaluating injury control programs.

AGENCY SPONSOR: National Center for Injury Prevention and Control

FEDERAL CONTACT: Sacks, Jeffrey, M.D.
770-488-4652

PIC ID: 4522

PERFORMER: Battelle Corporation
Arlington, VA

Empirical Testing of Early Warning Signs and Protective Factors in Intimate Partner Violence Prevention

The purpose of this project is to analyze the focus group findings of "Identification of Early Warning Signs and Protective Factors in Intimate Violence Prevention," and to test empirically these findings by conducting an Early Warning Signs and Protective Factors random digit dial national survey. The survey will gather data from approximately 1,800 women using an interview protocol which was developed and pilot tested in conjunction with that study. This instrument has also been refined by experts and Centers for Disease Control and Prevention (CDC) program staff. The protocol is a product of 24 focus groups conducted in five geographic regions of the country with women who had experienced various levels of violence in their intimate relationships. Participants included: (1) rural African American women, (2) urban African American women, (3) rural Caucasian women, and (4) urban Caucasian women. All women recruited for the focus groups had ended intimate violence in their lives either by leaving a relationship or through particular strategies to stop the abuse within the relationship. The purposes of the original study were to: (1) identify early warning signs for physical violence perpetrated by an intimate partner, (2) identify strategies women use to remove themselves from the violence, (3) examine individual risk or protective factors which affect escalation or cessation of violence in abusive relationships, (4) examine the differences in behavioral risk and protective factors for groups of women, (5) uncover factors that influence women's abilities to identify early warning signs, and (6) explore whether certain desistance strategies used by women are inevitably successful. The survey extends the scope of the focus group results and seeks to empirically test the initial findings by enlarging and randomizing the sample.

AGENCY SPONSOR: National Center for Injury Prevention and Control

FEDERAL CONTACT: Short, Lynn, Ph.D.
770-488-4285

PIC ID: 6341

PERFORMER: Macro International, Inc.
Silver Spring, MD

Prevention Services

Evaluation of the Behavioral Risk Factor Surveillance System (BRFSS) as a Source for National Estimates of Selected Health Risk Behaviors

This study was designed to evaluate the feasibility of computing national estimates using Behavioral Risk Factor Surveillance System (BRFSS) data. Specifically, the objectives were to: Develop a method for combing BRFSS state estimates to produce national risk factor prevalence estimates; Compare national BRFSS estimates computed using the new method with prevalence estimates from the National Health Interview Survey (NHIS); and Investigate time trends in national BRFSS national estimates. Twenty (20) key health risk factors from the BRFSS were used for this analysis, which occurred over a three year period. Only a few statistically significant temporal changes were identified in the 20 health risk factors examined. The analysis, however, indicates that national estimates based on BRFSS data are sufficiently precise to identify relatively modest year-to-year changes in risk factor prevalence. BRFSS is, therefore, very useful for annual national surveillance of behavioral risk factors, and is a useful adjunct to less-frequently conducted but more comprehensive surveys such as the National Health and Nutrition Examination Survey (NHANES).

AGENCY SPONSOR: National Center for Chronic Disease Prevention and Health Promotion

FEDERAL CONTACT: Powell-Griner, Eve E.
770-488-2524

PIC ID: 7039

PERFORMER: Battelle Corporation
Arlington, VA

Evaluation of the C. Everett Koop Community Health Information Center (CHIC)

Community health centers have the potential to facilitate the dissemination of the effective and accurate health communication products produced by the Centers for Disease Control (CDC) and its partners. Because of this potential, CDC's National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) became interested in understanding the effectiveness of community health information centers in meeting the health information needs of the general public. One such case is the C.Everett Koop Community Health Information Center (CHIC) created by the College of Physicians of Philadelphia in 1995. CDC contracted with Macro International to evaluate the effectiveness of the CHIC products and services; the use of the products and services and the effectiveness of outreach with a variety of agencies and community- based groups. A Patron Survey was developed and completed by a total of 267 individuals. Results indicated the CHIC must: do more to increase its visibility within the community by developing relationships with referral agents such as the media, physicians, or other libraries; continue to acquire and develop pamphlets for patrons to take with them; provide more pamphlets in languages other than English to serve the needs of local Philadelphia residents; consider operating on extended hours or on the weekends; and continue to be a free library offering research access to patrons.

AGENCY SPONSOR: National Center for Chronic Disease Prevention and Health Promotion

FEDERAL CONTACT: Fralish, Christine
770-488-5050

PIC ID: 6709

PERFORMER: Macro International, Inc.
Atlanta, GA

Evaluation of the Policies, Practices and Implementation of HIV Education Programs in Schools

This study evaluated the progress and activities conducted by the 71 HIV education programs funded by the Centers for Disease Control and Prevention's (CDC) Division of Adolescent and School Health (DASH). The programs were funded through cooperative agreements with State and local education agencies. Data elements were obtained from reading the program file documents and were abstracted for each funded year of the five-year period, 1987-1992, for each program. A database was composed from these elements that will allow CDC to answer specific evaluation questions regarding the development of programs and the extent to which the CDC policies and guidelines were followed during the funding period.

AGENCY SPONSOR: National Center for Chronic Disease Prevention and Health Promotion

FEDERAL CONTACT: Hunt, Pete
770-488-5343

PIC ID: 6070

PERFORMER: Macro International, Inc.
Atlanta, GA

In-Progress Evaluations

Chronic Disease

Evaluation of Implementation/Impact of VRE Guidelines

In response to the recent emergence of vancomycin resistance among enterococci (VRE), the Centers for Disease Control and Prevention (CDC) published "Recommendations for Preventing the Spread of Vancomycin Resistance." The purposes of this study are to determine the efficacy of different types of VRE control measures and their costs, and to develop a community- wide facility approach to VRE control.

AGENCY SPONSOR: National Center for Infectious Diseases

FEDERAL CONTACT: Tokars, Jerome, M.D., MPH
404-639-6418

PIC ID: 6703

PERFORMER: Health Care Financing Administration
Baltimore, MD

EXPECTED DATE OF COMPLETION: 08/31/2000

Strategic Plan for the National Diabetes Control Program

In light of major changes in funding and further developments of core capacity and infrastructure of State diabetes control programs, there is a need to step back and form a collective vision of the National Diabetes Control Program. This vision will form the basis for the FY 1999-2000 National Diabetes Control Program announcement for cooperative agreement renewals.

AGENCY SPONSOR: National Center for Chronic Disease Prevention and Health Promotion

FEDERAL CONTACT: Murphy, Dara

PIC ID: 7051

PERFORMER: Macro International, Inc.
Atlanta, GA

EXPECTED DATE OF COMPLETION: 09/30/2001

Cross-Cutting

Urban Health Systems Sentinel Network

This project will coordinate a review of the Centers for Disease Control and Prevention's (CDC) analysis of the impact of restructuring on essential public health services in Los Angeles County. It will collect case study data in up to six urban public health systems impacting the capacity to deliver essential public health services. It will also describe a set of predictive relationships applicable to other State and local health departments.

AGENCY SPONSOR: Public Health Practice Program Office

FEDERAL CONTACT: Sinnock, Pomeroy, Ph.D.
770-488-2469

PIC ID: 6276

PERFORMER: Macro International, Inc.
Atlanta, GA

EXPECTED DATE OF COMPLETION: 09/30/2000

Environmental Health

Evaluation of the ZAP Asthma Program

The purpose of this project is to conduct a process evaluation of the following two components of the ZAP Asthma Project: (1) the project's health education component, health communication component and the project's use of community health workers; and (2) the process of public/private/community collaboration, community engagement and empowerment, and systems improvement and capacity building at the community level.

AGENCY SPONSOR: National Center for Environmental Health

FEDERAL CONTACT: Rifenburg, James
770-488-7322

PIC ID: 7048

PERFORMER: Macro International, Inc.
Atlanta, GA

EXPECTED DATE OF COMPLETION: 09/30/2000

Folic Acid and the Prevention of Spina Bifida

This project proposes to evaluate the effectiveness of a free folic acid supplement distribution program in a family planning setting using blood folate determinates in conjunction with questionnaires of knowledge and supplement use behaviors.

AGENCY SPONSOR: National Center for Environmental Health

FEDERAL CONTACT: Watkins, Margaret
770-488-7187

PIC ID: 7042

PERFORMER: Battelle Corporation
Arlington, VA

EXPECTED DATE OF COMPLETION: 08/31/2001

Epidemiology

Evaluation of the National Electronic Telecommunication System for Surveillance and the Public Health Laboratory Information System

This project was undertaken to provide the Centers for Disease Control and Prevention (CDC) with a better understanding of the utilization of data collected by state and territorial health agencies and transmitted to CDC’s Epidemiology Program Office (EPO) over their National Telecommunications System for Surveillance.

AGENCY SPONSOR: Epidemiology Program Office

FEDERAL CONTACT: Baron, Roy, M.D., M.P.H.
404-639-2697

PIC ID: 6332

PERFORMER: Battelle Corporation
Arlington, VA

EXPECTED DATE OF COMPLETION: 03/01/2000

Evaluation of the Public Health Prevention Service

In 1997 the Epidemiology Program Office established the Public Health Prevention Service (PHPS), a new three-year training program, designed to improve the Nation's public health practice by preparing entry-level public health professionals to conduct prevention programs. This evaluation project will establish the foundation for a monitoring and evaluation system designed to provide feedback to the PHPS program for continuous improvement.

AGENCY SPONSOR: Epidemiology Program Office

FEDERAL CONTACT: Jarvis, Dennis
404-639-4087

PIC ID: 7038

PERFORMER: Macro International, Inc.
Atlanta, GA

EXPECTED DATE OF COMPLETION: 09/11/2001

Health Statistics

Evaluation of Medicaid Reporting Using SLAITS

The State and Local Area Integrated Telephone Survey (SLAITS) is a newly developed survey mechanism which utilizes the sampling frame and screening procedures of the ongoing National Immunization Survey (NIS). The object of this project is to evaluate SLAITS as a modality for monitoring State performance in implementing the State Children's Health Insurance Program during a period of rapid State restructuring of health and welfare institutions.

AGENCY SPONSOR: National Center for Health Statistics

FEDERAL CONTACT: Cynamon, Marcie
301-436-7085

PIC ID: 7046

PERFORMER: Robert Wood Johnson Foundation
Princeton, NJ

EXPECTED DATE OF COMPLETION: 09/30/2000

Evaluation of the NHIS--Survey of Sentinel Health Indicators

This project proposes to evaluate the potential of the National Health Interview Survey (NHIS) for the surveillance of sentinel health indicators in the U.S.

AGENCY SPONSOR: National Center for Health Statistics

FEDERAL CONTACT: Hardy, Ann, Dr
301-436-7085

PIC ID: 7040

PERFORMER: TRW Government Information Services
Fairfax, VA

EXPECTED DATE OF COMPLETION: 09/30/2001

Evaluation of the U.S. Standard Certificates

The overall objective of this project is to evaluate the birth, death and fetal death information currently obtained from State vital registration programs to determine if relevant and high quality data are being collected for State and national decision making. The assessment will also consider what changes should be made to the standard certificates to improve their use and utility.

AGENCY SPONSOR: National Center for Health Statistics

FEDERAL CONTACT: Kowaleski, Julia
301-436-8815

PIC ID: 6699

PERFORMER: Laurel Consulting Group
Laurel, MD

EXPECTED DATE OF COMPLETION: 06/20/2000

HIV/STD/TB Prevention

Community Indicators -- Literature Search

This request for services is to assist in a search for literature and other information that identifies cultural and social-structural characteristics of communities that are associated with HIV/AIDS risk behavior and prevention efforts. Materials and information found in the search will be used to support community-level research on HIV/AIDS prevention.

AGENCY SPONSOR: National Center for HIV, STD, and TB Prevention

FEDERAL CONTACT: Sumartojo, Esther
404-639-8300

PIC ID: 6701

PERFORMER: Macro International, Inc.
Atlanta, GA

EXPECTED DATE OF COMPLETION: 10/01/1999

Evaluation of CDC's STD Treatment Guidelines

The objective of this project is to evaluate the impact of STD treatment guidelines in public and private settings, to identify factors associated with compliance with guidelines, and assess the relationship between adherence to guidelines and associated health outcomes.

AGENCY SPONSOR: National Center for HIV, STD, and TB Prevention

FEDERAL CONTACT: Irwin, Ruth, M.D.
404-639-8956

PIC ID: 7047

PERFORMER: The HMO Group
New Brunswick, NJ

EXPECTED DATE OF COMPLETION: 09/01/2000

Survey of Syphilis and HIV Treatment, Reporting

The purpose of this project is to conduct a survey of a sample of physicians' diagnosis, treatment, reporting and partner management practices for syphilis and HIV infection. The study will determine when, under what conditions, for which diseases, how and for which patients, practitioners notify and/or treat the sexual partners of patients who are diagnosed with syphilis and HIV infection.

AGENCY SPONSOR: National Center for HIV, STD, and TB Prevention

FEDERAL CONTACT: St. Lawrence, Janet, Ph.D.
404-639-8376

PIC ID: 7054

PERFORMER: Battelle Corporation
Arlington, VA

EXPECTED DATE OF COMPLETION: 11/15/2000

Immunization

Evaluation of the Use of Data from Immunization Information Systems

Currently, at least 22 States have immunization information systems (IIS) functioning either State-wide or in some counties or local communities. At this point in the development cycle, it is important to evaluate how the data in the IIS are used. If it is understood how these data are used and structural and functional barriers to data use can be identified, recommendations can be made to promote the full use of these data resources.

AGENCY SPONSOR: National Immunization Program

FEDERAL CONTACT: Stevenson, John
404-639-8730

PIC ID: 6713

PERFORMER: Advanced Technology Systems
Johnson City, TN

EXPECTED DATE OF COMPLETION: 12/31/2000

Infectious Disease

Evaluation of the Effectiveness of Group B Streptococcal Disease Prevention Guidelines

Group B Streptococcus (GBS) is the leading cause of bacterial infection in newborns in the United States. This project will assess a number of issues that affect successful management of GBS disease in the United States.

AGENCY SPONSOR: National Center for Infectious Diseases

FEDERAL CONTACT: Schuchat, MD, Anne
404-639-2215

PIC ID: 6333

PERFORMER: American Association of Health Plans
Washington, DC

EXPECTED DATE OF COMPLETION: 09/30/2000

Injury/Violence Prevention

Evaluation of NCIPC Injury Control Recommendations for Bicycle Helmets

The National Center for Injury Prevention and Control (NCIPC) published recommendations on the use of bicycle helmets in preventing head injuries in the Morbidity and Mortality Weekly Report (MMWR) of February 17, 1995. The publication includes information on the magnitude of the problem of bicycle-related head injuries; the potential impacts of increased helmet use; helmet standards and performance in actual crash conditions; barriers that impede increased helmet use; and approaches to increasing the use of bicycle helmets within the community. The bicycle helmet recommendations are the first in a series of planned injury control recommendations from NCIPC. The evaluation of the bicycle helmet guidelines offers a timely opportunity to explore "lessons learned" before NCIPC develops and disseminates future guidelines.

AGENCY SPONSOR: National Center for Injury Prevention and Control

FEDERAL CONTACT: Sacks, Jeffrey, M.D.
770-488-4652

PIC ID: 6700

PERFORMER: Battelle Corporation
Arlington, VA

EXPECTED DATE OF COMPLETION: 3/1/2000

Prevention Services

Evaluating the Responsiveness of Guide to Community Services

In 1996, a Task Force of non-Federal public health experts were appointed to develop a Guide to Community Preventive Services. An evaluation of the Guide is proposed to field test and evaluate six Guide modules addressing three study areas.

AGENCY SPONSOR: Public Health Practice Program Office

FEDERAL CONTACT: Sinnock, Pomeroy, Ph.D.
770-488-2469

PIC ID: 7043

PERFORMER: Mathematica Policy Research, Inc.
Princeton, NJ

EXPECTED DATE OF COMPLETION: 09/30/2001

Evaluation of Public Health Care Providers Training, Screening and Referral Practice

This project will conduct national population-based surveys of administrators and clinical providers in family planning programs funded by Titles X and XX, maternal and child health programs funded by Title V, and the federally-funded Primary and Migrant Health Centers. The information obtained from these surveys will be used to develop recommendations for the development of future clinical guidelines.

AGENCY SPONSOR: National Center for Chronic Disease Prevention and Health Promotion

FEDERAL CONTACT: Spitz, Alison
770-488-5260

PIC ID: 6712

PERFORMER: Battelle Corporation
Arlington, VA

EXPECTED DATE OF COMPLETION: 10/30/2000

Evaluation of Teen Pregnancy Interventions

The purpose of this project is to address the assessment and testing of interventions and the evaluation of adolescent pregnancy prevention initiatives in 13 cities in the United States. The objectives of the study are to assist the 13 cooperative agreement cities in field testing components of their teen pregnancy prevention intervention programs.

AGENCY SPONSOR: National Center for Chronic Disease Prevention and Health Promotion

FEDERAL CONTACT: Dalmat, Michael
404-488-5136

PIC ID: 6274

PERFORMER: Battelle Corporation
Arlington, VA

EXPECTED DATE OF COMPLETION: 04/30/2000

Food and Drug Administration

MISSION: To protect and promote public health through food, drug, medical device, and cosmetic regulation.

Evaluation Program

The Food and Drug Administrations FY 1998 Evaluation Program ultimately reflected some of the goals established and promulgated by the Department of Health and Human Services (HHS) for which FDA has responsibility. HHSs goals are products of its strategic performance planning process, and FDA uses its own strategic framework to accomplish these goals. This process also satisfies the implementation requirements of the Government Performance and Results Act (GPRA) and the Food and Drug Administration Modernization Act of 1997 (FDAMA). The strategic and performance process is an evolving set of program directions for FDA as changes occur in FDAs dynamic environment. FDAs challenges, now and in the future, will rest on its ability to leverage it efforts in that environment, which grows increasingly complex and more institutionally networked. The Agency will strive to maintain the scientific knowledge base necessary to achieve greater effectiveness in assuring the quality and availability of the products it regulates.

One goal area within FDA’s strategic framework is Pre-Market Review, where the objective is to make timely and cost-effective pre-market review decisions, while assuring product safety and efficacy. The results achieved and reported in the Prescription Drug User Fee Act (PDUFA) FY 1998 Performance Report, are one indication of how well FDA is meeting its goal of making timely pre-market review decisions. FDA exceeded all of the performance goals specified under PDUFA. The focus of these performance goals is to expedite the entire drug development and review process, from research to approval, without compromising the safety or the quality expected from the Agency’s application review process.

Another goal area within FDA’s strategic framework is Internal Capacity, which focuses onFDA’s ability to make effective pre and post-market regulatory decisions. One strategy for accomplishing this goal is through the implementation of decision-supportive information systems where reporting burdens are being reduced for the regulated industry. For example, FDAMA has afforded FDA greater flexibility in the scope and amount of data collected and reported on medical devices than was possible under the previous mandate. The Agency has reevaluated the requirements already in place, removing those that no longer made sense from a public health perspective. As a result, hundreds of device tracking and post-market surveillance orders were rescinded for more than a dozen product types. FDAMA also enabled FDA to modify its user-facility reporting program for medical devices from a mandated universe of facilities to a representative sample of facilities.

External Leveraging, another element of FDA’s strategic framework, represents a significant shift in FDA’s direction for the twenty-first century as the Agency works to leverage a more technologically complex environment. One strategy involves fostering industry quality assurance programs, thereby capitalizing on the quality and safety control capabilities already resident in the regulated industry. HACCP (Hazard Analysis Critical Control Point) programs and the implementation of the Mammography Quality Standards Act (MQSA) are two examples of this approach that are underway.

The fourth and final goal area within FDA’s strategic framework is Post-Market Assurance, a goal that strives to strengthen the assurance that products on the market, or about to enter the market, are safe. One strategy of accomplishing this goal is by targeting high-risk products. The Tobacco Program illustrated one of the initiatives in this area. Prior to the court decision that ended this program, FDA planned to reduce access to tobacco products by youths under 18 through new FDA requirements for retailers.

Fiscal Year 1999 Evaluation Reports

Biologics Evaluation

Interferon Beta-1b Injection Site Reactions and Necroses

The article entitled, "Interferon beta-1b injection Site Reactions and Necroses," appearing in Multiple Sclerosis in May of 1998, explores the safety of Betaseron (interferon beta-1b). Beta interferon was first licensed for injection treatment of multiple sclerosis in 1993. It has generated the largest number of adverse event reports received by the Food and Drug Administration (FDA), with 8,300 reports received between 1995 and 1996. This represented the largest summary of adverse event data for a biological therapeutic product ever compiled at the agency. The findings in the report led to changes in product labeling, thereby reducing the risk of severe site reactions and necroses in multiple sclerosis patients.

AGENCY SPONSOR: Food and Drug Administration

FEDERAL CONTACT: Gaines, Ann
301-827-3974

PIC ID: 7093

PERFORMER: Food and Drug Administration
Rockville MD

Cross-Cutting

Potential Benefits of Pediatric Information: Background Paper

This analysis examines the potential benefits of new regulations the FDA is preparing to issue which would require pediatric studies of certain new and marketed drug and biological products. The regulations address two major problems associated with the lack of adequate information on the effects of drugs on pediatric patients: (1) frequent adverse drug reactions in children due to inadvertent drug overdoses or other drug administration problems that could be avoided with better information on appropriate pediatric use, and (2) frequent underuse of safe and effective drugs for children, due to the prescribing of an inadequate dosage or regimen, a less effective drug, or no drug at all, because of uncertainty over its effect on children or the lack of a pediatric formulation. By developing improved information on whether, and in what dosage, a drug is safe and effective for use in children, FDA believes that the regulation will result in fewer adverse drug reactions and fewer instances of less-than-optimal treatment of pediatric patients.

AGENCY SPONSOR: Office of Planning, Policy & Legislation

FEDERAL CONTACT: Braslow, Lawrence
301-827-5331

PIC ID: 7272

PERFORMER: Food and Drug Administration
Rockville MD

Drug Application Review

Establishing Mechanisms for Meeting Review Time Periods Specified in the Food, Drug, and Cosmetic Act

This report was prepared in response to Section 406(b) of the Food and Drug Modernization Act of 1997 (FDAMA) which stipulates that by July 1, 1999, FDA establish mechanisms for meeting review times for applications and submissions as specified in its enabling legislation. The report summarizes a listing of 110 mechanisms as of July 1, 1999 that were ascertained from FDA documents. These mechanisms were developed within the context of six strategic directions set forth in the FDA Plan for Statutory Compliance-November 1998, representing a combination of approaches that have reached a focal point as a result of FDAMA.

AGENCY SPONSOR: Office of Planning, Policy & Legislation

FEDERAL CONTACT: McEvoy, Kate
301-827-5251

PIC ID: 7273

PERFORMER: Office of Policy, Planning, and Legislation, FDA
Rockville MD

Office of New Drug Chemistry: Annual Report of Statistical Data

Workload and accomplishments data for investigational new drug applications and new drug applications for fiscal year 1998 is compiled by the Office of New Drug Chemistry of the FDA's Office of Pharmaceutical Science on an annual basis and reported in this publication. Data include the number of submissions received, by type and quantity; trends in rate of original receipts; forecasts of workload for the next fiscal year with possible personnel requirements; adherence to schedules; and analysis of completed reviews.

AGENCY SPONSOR: Center for Drug Evaluation and Research

FEDERAL CONTACT: Sherwood, Ted
301-827-5845

PIC ID: 7274

PERFORMER: Food and Drug Administration
Rockville, MD

Food Safety and Nutrition

Away-From-Home Foods Increasingly Important to Quality of American Diet

The increasing popularity of dining out over the past two decades has raised the proportion of nutrients obtained from away- from-home food sources. Between 1977 and 1995, home foods significantly improved their nutritional quality, more so than away-from-home foods, which typically contained more of the nutrients overconsumed (fat and saturated fat) and less of the nutrients under-consumed (calcium, fiber, and iron) by Americans. Since the trend of eating out frequently is expected to continue, strategies to improve the American diet need to address consumers' food choices when eating out.

AGENCY SPONSOR: Center for Food Safety and Applied Nutrition

FEDERAL CONTACT: Guthrie, JoAnne
202-205-4179

PIC ID: 7294.2

PERFORMER: Food and Drug Administration
Rockville, MD

Background Research and Recommendations for the Food Safety Campaign

A survey conducted by the Center for Food Safety and Applied Nutrition in 1997 revealed that restaurant patrons did not want to be reminded about risks when ordering, found proposed menu labels repulsive, and said they already knew too much to get any benefit from them. To overcome such barriers to information dissemination and to develop a strategic approach to educating consumers about food safety, further research was conducted. This report presents a compendium of evaluations of recent food safety education programs, recent consumer surveys and qualitative consumer research related to food safety issues, epidemiological data on the magnitude and distribution of foodborne illness in the United States, and microbiological/risk assessment analyses of food consumption, handling, and preparation practices that increase or decrease the likelihood of foodborne illness. The report considers information obtained from meetings with experts identifying critical objectives, presents a comprehensive summary of the qualitative and quantitative research on food safety issues, identifies the information needs for developing a strategic approach to consumer education, and summarizes the results of focus groups conducted to meet those needs. Finally, the report encapsulates expert opinions on designing education programs and communication strategies to change food-handling behavior and presents proposals for developing a successful consumer food safety campaign.

AGENCY SPONSOR: Center for Food Safety and Applied Nutrition

FEDERAL CONTACT: Levy, Alan
202-205-9448

PIC ID: 7275

PERFORMER: Sutton Social Marketing
Washington, DC

Changes in Consumers' Knowledge of Food Guide Recommendations, 1990-91 vs 1994-95

This paper was prepared in order to assess people's awareness of specific food group recommendations of the Food Guide Pyramid between 1990-91 and 1994-95. Data included individuals who said they were using the main meal planners (from smapling procedure 1989-91) in their households. In 1994-95 the percentage of adults who believed they needed to consume a number of servings daily from each of the five major food groups corresponding to the Food Guide Pyramid varied considerably among food groups. For example, one half to about three-fifths of adults gave an answer that was within the correct range for the vegetable group, yet only 7 percent reported the correct recommendation for the bread, cereal, grains, and pasta group. The findings indicate, that for four of the five food groups, at least 50 percent of adults believe they should consume the number of servings recommended by the Food Guide Pyramid. Previous research indicated that knowledge of serving recommendations is associated with intakes of food groups that more closely match recommendations. Thus, increasing people's knowledge of food group serving recommendations is one strategy for improving diet quality.

AGENCY SPONSOR: Center for Food Safety and Applied Nutrition

FEDERAL CONTACT: Guthrie, JoAnne
202-205-4179

PIC ID: 7294.1

PERFORMER: Food and Drug Administration
Rockville, MD

Developmental Research for the FDA Food Safety Consumer Education Campaign on Unpasteurized Juice

This report describes the Food and Drug Administration's (FDA) development of information to include warning statements on packaged fruit and vegetable juice products that could contain life-threatening microorganisms. FDA contracted with Macro International to develop and test this information through the use of focus groups and qualitative research. The three focus groups consisted of three target populations: (1) parents of small children; (2) persons over the age of 60; and (3) members of the general public. The objective of the focus groups was to obtain consumer feedback on pasteurization effects and other treatment procedures on fruit and vegetable juices. The comments made by the three focus groups did not differ. Discussions included topics such as product and purchasing decisions, hazards awareness associated with unpasteurized juice, label information, and contents of brochure and warning labels.

AGENCY SPONSOR: Center for Food Safety and Applied Nutrition

FEDERAL CONTACT: Heaton, Alan
202-205-5394

PIC ID: 7081

PERFORMER: Macro International, Inc.
Calverton, MD

Economic Characterization of the Dietary Supplement Industry

The Food and Drug Administration's (FDA), under contract with RTI, collected information, on the nature, size, and scope of the dietary supplement (DS) industry. The products that are the focus of this report are based on the definition of dietary supplements in the Dietary Supplement Health and Education Act of 1994 (DSHEA). They are: (1) vitamins; (2) minerals; (3) herbals and other botanicals; (4) amino acids; (5) dietary substances used to supplement the diet by increasing its total daily intake; and (6) concentrates, metabolites, constituents, extracts, and combinations of these ingredients. Nearly all of the information contained in this report was obtained from secondary data sources. In addition, RTI met with individuals to obtain further information on the industry. As new products are introduced, the range of DS products will continue to grow. Small manufacturers may be unable to serve the larger retailers that are increasingly selling DS products. Sales of these products by mass merchandisers such as Costco and Kmart are increasing and are expected to continue to grow. Consumers seeking consistent quality of products migrate toward particular brand names; the larger manufacturing firms are more likely to have the resources to maintain such quality, and the advertising budgets to establish brand name recognition. Due to rapid growth, the DS industry has attracted attention of Wall Street investors -- the influx of outside investment dollars will help continue the growth of this industry, both by adding new products and by serving additional markets.

AGENCY SPONSOR: Center for Food Safety and Applied Nutrition

FEDERAL CONTACT: Nardinelli, Clark
202-205-8702

PIC ID: 6865.1

PERFORMER: Research Triangle Park
Research Park, NC

Is There Competition Between Breast-Feeding and Maternal Employment?

Theory suggests that the decision to return to employment after childbirth and the decision to breast-feed may be jointly determined. Models of simultaneous equations were estimated for two different aspects of the relationship between maternal employment and breast feeding using 1993-1994 data from the U.S. Food and Drug Administration's Infant Feeding Practices Study. The researchers first explored the simultaneous duration of breast-feeding and work leave following childbirth. It was found that the duration of leave from work significantly affects the duration of breast-feeding, but the effect of breast-feeding on work leave is insignificant. The report estimate models of the daily hours of work and breast-feedings at infant ages 3 months and 6 months postpartum. At both times, the intensity of work effort significantly affects the intensity of breast- feeding, but the reverse is generally not found. Competition clearly exists between work and breast-feeding for many women in the sample.

AGENCY SPONSOR: Center for Food Safety and Applied Nutrition

FEDERAL CONTACT: Fein, Sara, Ph.D.
202-205-5349

PIC ID: 7294.4

PERFORMER: Food and Drug Administration
Rockville, MD

The Effects of Education and Information Source on Consumer Awareness of Diet – Disease Relationships

Health-related information provided by the news media is associated with increases in consumer awareness of diet -- disease relationships. This project focuses its awareness analysis on four diet - disease relationships: (1) cancer and fat; (2) heart disease and fat; (3) cancer and fiber; and (4) high blood pressure and sodium between 1984 and 1995 when timing and quantity of information varied across diet - diseases and information sources. This study shows that consumer awareness increased during times of increased news media activity, and decreased during increased time of advertising activity, possibly due to a low level of credence of producer - provided health information. No strong evidence was found to show either media or producer information decreased the difference in awareness between more and less educated individuals.

AGENCY SPONSOR: Center for Food Safety and Applied Nutrition

FEDERAL CONTACT: Levy, Alan
202-205-9448

PIC ID: 7238

PERFORMER: Food and Drug Administration
Rockville MD

The Impact of Health Claims on Consumer Search and Product Evaluation Outcomes: Results from FDA Experimental Data

This report provides the results of a study on the effects of health claims on consumer information search and processing behavior, and discusses the issues surrounding the regulation of health claims on food labels. Health claims on food labels are currently regulated under the 1990 Nutrition Labeling and Education Act (NLEA) with implementing rules that were issued in May 1994 by the U.S. Food and Drug Administration (FDA). The passage of NLEA was motivated in part by consumers and regulators who were concerned that unregulated health claims might be confusing and deceptive. It has been suggested that limiting the types and number of health claims may be costly; there has also been some evidence that consumers are capable of evaluating information from the Nutrition Facts panel, even when a contradictory health claim is on the front panel. This article introduces experimental data that suggests that the presence of health and nutrient-content claims on food packages will cause consumers to truncate their information search to the front panel of packages. The presence of a claim was associated with a more positive consumer summary judgment of products, and greater weight was given to the information mentioned in claims, than to information in the Nutritional Facts panel.

AGENCY SPONSOR: Center for Food Safety and Applied Nutrition

FEDERAL CONTACT: Levy, Alan
202-205-9448

PIC ID: 7237

PERFORMER: Food and Drug Administration
Rockville MD

What People Know and Do Not Know About Nutrition

This report looks at how much the typical American knows about nutrition, whether the average level of nutrition knowledge has increased, and what implications this has for changing eating habits. Using data from a variety of public and private sources (including the Food and Drug Administration's (FDA) Health and Diet Survey (HDS)), the U.S. Department of Agriculture's (USDA) Diet and Health Knowledge Survey (DHKS), the Food Marketing Institute's (FMI) Trends Survey, and the American Dietetic Association's (ADA) 1995 Nutrition Trends Survey, the level of nutrition knowledge among American consumers was examined. In general, to develop effective nutrition education and promotion messages, nutritionists need to consider what types of knowledge are most needed and how much knowledge average individuals can reasonably be expected to assimilate. An important step in promoting dietary change is to identify the nutrition-related knowledge and skills most needed by consumers and to develop simplifying tools such as the Food Guide Pyramid or the nutrition label to communicate them.

AGENCY SPONSOR: Center for Food Safety and Applied Nutrition

FEDERAL CONTACT: Levy, Alan
202-205-9448

PIC ID: 7294.3

PERFORMER: Food and Drug Administration
Rockville MD

Medical Devices

Breast Imaging: Mammography in the 1990's: The United States and Canada

This study was undertaken to evaluate trends in mammography quality before and after the implementation of the Mammography Quality Standards Act (MQSA) of 1992 and to compare technical data collected in the US with corresponding data obtained from the first survey of mammography facilities conducted in 1994-1995 in Canada. Data from MQSA inspections conducted in 1995-1997 were analyzed and compared with survey data on U.S. mammography facilities acquired before the MQSA. Technical indicators of mammography quality such as radiation dose, phantom image score, film processing, and darkroom fog were analyzed. The results indicate continuous improvement since 1985 in the US in areas such as phantom image scores, darkroom fog, and x-ray beam quality. The US mean glandular dose has increased to 1.6 mGy compared with the Canadian dose of 1.1 mGy. The mean total phantom image score with artifact subtraction was 11.1 in Canada in 1994-1995 and 11.8 in the US in 1997. The conclusions are that mammography quality is better today than it has been at any other time in the US and with the exception of radiation dose, Canadian technical measures of performance are comparable to measures before MQSA in the United States.

AGENCY SPONSOR: Office of Planning, Policy & Legislation

FEDERAL CONTACT: Tucker, Steve
301-827-5339

PIC ID: 6080.3

PERFORMER: Food and Drug Administration
Rockville MD

FDA Public Health Advisory: Need for Caution When Using Vacuum Assisted Delivery Devices

The Center for Devices and Radiological Health surveyed a random sample of 308 recipients of the Public Health Advisory on vacuum assisted delivery devices. The purpose of the survey was to help the Center evaluate the format and content of the Advisory, as well as its effectiveness as a means of communication. The survey was conducted during March, 1998, and has a sampling error of plus or minus 10 percentage points. Some highlights of the survey are as follows: ninety-nine percent of the respondents said the problem addressed in the advisory was clearly identified and easily understood. The respondents agreed that the actions for reducing risk in the Alert were clearly explained (86%), and that the Alert information was useful (81%) and timely (76%). Sixty-two percent would like to continue to receive future alerts, as they are currently sent, in printed form.

AGENCY SPONSOR: Center for Devices and Radiological Health

FEDERAL CONTACT: Blanken, Gary
301-594-1284

PIC ID: 6733.1

PERFORMER: Food and Drug Administration
Rockville MD

Final Report of a Study to Eval. the Feas. and Effectiv. of a Sentinel Reporting Syst. for Adverse Event Reporting of Med. Devices in User Facilities

This report outlines the first phase of the program to evaluate the feasibility and effectiveness of a new sentinel reporting system for documenting adverse events (those ending in serious injury or death) for medical devices in user facilities (See also PIC ID# 7108). It describes the schedule of events, the exploratory research performed before the study was launched, how the participating facilities were recruited and trained, the process of data collection, how the channels of communication were established among the participating facilities and the government and the results of qualitative and quantitative analyses. Such topics as overcoming reticence to participation and enhancing communication through use of newsletters and other devices are also discussed.

AGENCY SPONSOR: Center for Devices and Radiological Health

FEDERAL CONTACT: Gardner, Susan
301-594-2812

PIC ID: 7108.1

PERFORMER: Food and Drug Administration
Rockville MD

Mammography Quality Standards Act: Third Annual Government Entity Declaration Program Audit 1998

This report details the results of the third audit of the Mammography Quality Standards Act (MQSA) Government Entity (GE) Declaration Program. The goal of the audit was to 1) notify facilities that they would be held accountable for their self- certification of fee exemption, and 2) to determine the rate of compliance with the program. Ninety out of 793 claiming GE status were randomly selected for review. A second sample of 51 facilities was reviewed out of 138 that had recently claimed fee exemption status while having paid a fee in the past. The 1993 GE audit yielded the same results as the 1997 GE audit-- a 97% compliance rate. Three of the facilities were not confirmed as government entities. The second sample yielded a 100% compliance rate. The appendices to the report contain the names of the facilities, numbers, and audit results. Recommendations for the GE Declaration Program include: 1) publish the results in "Mammography Matters" as in previous years; 2) calculate future audit samples from three groups: facilities claiming CDC funding; facilities claiming GE status, and facilities claiming GE status that previously paid. The sample would come from three groups rather than 2 groups, using the same statistical calculation to achieve a high confidence level.

AGENCY SPONSOR: Office of Planning, Policy & Legislation

FEDERAL CONTACT: Tucker, Steve
301-827-5339

PIC ID: 6080.2

PERFORMER: Food and Drug Administration
Rockville MD

In-Progress Evaluations

Cross-Cutting

Real-Time PMA Supplement Program Evaluation

The Office of Device Evaluation (ODE), Food and Drug Administration (FDA) is implementing the "Real-Time" program for pre-market application (PMA).

AGENCY SPONSOR: Center for Devices and Radiological Health

FEDERAL CONTACT: Munson, Maryann
301-594-1284

PIC ID: 6732

PERFORMER: Food and Drug Administration
Rockville MD

EXPECTED DATE OF COMPLETION: 9/30/2000

Drug Application Review

Drug Metabolism: Drug-Drug Interactions

Recent examples of studies that have provided information to specific review decisions include: (1) interactions and metabolism studies of anti-cancer drugs such as paclitaxel, (2) anti-abuse drugs such as LAAM, (3) anti-HIV drugs such as the protease inhibitors, (4) anti-epileptic drugs, (5) cardiovascular drugs, and (6) anti-malarial drugs. In addition to the general technical expertise brought to bear on these problems, results from the program have been incorporated into final product labeling for some drugs, including paclitaxel and saquinavir. Labeling changes for other drugs are under discussion. Also, cutting-edge issues regarding cases of intermediate potency for cytochrome P450 pathways are under investigation.

AGENCY SPONSOR: Center for Drug Evaluation and Research

FEDERAL CONTACT: Collins, Jerry
301-427-1065

PIC ID: 7103

PERFORMER: Food and Drug Administration
Rockville MD

EXPECTED DATE OF COMPLETION: 10/1/2000

Laboratory Support Services for FDA Compliance and Surveillance

This initiative of the human drug program involves multiple evaluative aspects. Two examples are: (1) conducting the hormones surveillance program, and (2) developing analytical methods for drug fingerprinting in the assessment of drug quality. The anticipated outcome of this effort will support the Food and Drug Administration's (FDA's) regulatory actions by providing laboratory support for the agency's compliance and methods development functions. In addition, drug fingerprint profiles will provide forensic assessments of drug manufacturing origin in support of FDA investigational efforts in deterring drug counterfeiting.

AGENCY SPONSOR: Center for Drug Evaluation and Research

FEDERAL CONTACT: Hanig, Joe
301-594-5026

PIC ID: 7107

PERFORMER: Food and Drug Administration
Rockville MD

EXPECTED DATE OF COMPLETION: 9/30/2000

Methods Validation

The objective of this project is to verify the suitability of New Drug Approval (NDA) and Abbreviated New Drug Applications (ANDA) analytical methods for drugs, antibiotics and hormones for quality control and regulatory purposes.

AGENCY SPONSOR: Center for Drug Evaluation and Research

FEDERAL CONTACT: Hanig, Joe
301-594-5026

PIC ID: 7106

PERFORMER: Food and Drug Administration
Rockville MD

EXPECTED DATE OF COMPLETION: 9/30/2000

Review of Therapeutic Agents as an Antimicrobial Adjunct in Treatment of Sepsis

Sepsis affects half a million people annually. Even though a large number of trials have been conducted, no therapeutic agent demonstrating clinical benefit or superiority to standard care has been identified. Designing clinical trials that have any probability of demonstrating efficacy is challenging, due to the heterogeneity of patient populations, poor understanding of the pathophysiology of acute sepsis, and lack of uniformly accepted standards of care in international trials. Intensive efforts have been undertaken by the Food and Drug Administration (FDA) to propose the optimal trial design and prospective analysis plans. Currently, an analysis of the failed sepsis trials is being initiated by the FDA with the hope of better clinical trials for the evaluation of the adjunctive therapy of sepsis in the future.

AGENCY SPONSOR: Center for Drug Evaluation and Research

FEDERAL CONTACT: Roberts, Rosemary, Ph.D.
301-827-2183

PIC ID: 6736

PERFORMER: Food and Drug Administration
Rockville MD

EXPECTED DATE OF COMPLETION: 10/1/2000

Food Safety and Nutrition

1997 Food Label and Package Survey (FLAPS): Status of Nutrition Labeling Health Claims, and Nutrient Content Claims on Processed Foods

The Food and Drug Administration (FDA) monitors food labels through the Food Label and Package Survey (FLAPS). FDA uses FLAPS as a tracking mechanism to keep abreast of the market response to regulations via changes in product package labels. The agency uses FLAPS data to support policy, regulatory, and food safety decisions, as well as economic impact assessments. For example, FDA has used FLAPS data to gain information on the prevalence of nutrition labeling on product packages; the extent of quantitative labeling of various nutrients, such as fatty acids; the extent of use of specific product ingredients (e.g., potassium bromate, monosodium glutamate, gelatin); the accuracy of product serving sizes; and the prevalence of various health claims on food products (e.g., the association between increased calcium and the reduced risk of osteoporosis.) In 1997, FDA conducted the eleventh FLAPS survey. The data reflect the status of processed, packaged food labels subsequent to the publication of regulations promulgated in response to the Nutrition Labeling and Education Act of 1990 (the NLEA). The current study focuses on nutrient content claims and health claims, as well as the percentage of packaged food products sold annually that bear quantitative nutrition labeling. Findings indicate that nutrition-labeled products accounted for an estimated 92% of the annual sales of processed, packaged foods. An additional 3% of the products sold were exempt from labeling. Nutrient content and health claims appeared on an estimated 39% and 4%, respectively, of the products sold.

AGENCY SPONSOR: Center for Food Safety and Applied Nutrition

FEDERAL CONTACT: Anderson, Ellen
202-205-5662

PIC ID: 5711.2

PERFORMER: A.C. Nielsen Company
Schaumburg IL

EXPECTED DATE OF COMPLETION: 9/30/2000

Economic Cost Benefit Studies: Analysis of Changing Food Labels to Include Information on Trans Fatty Acids

On February 14, 1994, the U.S. Food and Drug Administration (FDA) received a citizen petition from the Center for Science in the Public Interest (CSPI), requesting that the FDA amend the definition of saturated fatty acids to include trans fatty acids. The CSPI requested that certain fat and cholesterol claims be based on the combined level of saturated and trans-fatty acids. The FDA is currently preparing to respond to this petition through rulemaking. When considering rulemaking, the FDA is required to assess all costs and benefits of available regulatory alternatives and, when regulation is necessary, to select the regulatory approach that maximizes net benefits (including potential economic, environmental, public health and safety effects, distributive impacts, and equity.) A rule is classified as significant if it meets any one of a number of specified conditions, including having an annual effect on the economy of at least $100 million, or adversely affecting in a material way a sector of the economy, competition or jobs, or if it raises novel legal or policy issues. In addition, the FDA is required (by the Regulatory Flexibility Act) to determine the impact of its rules on small entities. To fulfill its requirements, the FDA needs certain information. This study will, address the impact of changing food labels in order to provide information on trans-fatty acids. (See also 6865, 6865.1)

AGENCY SPONSOR: Center for Devices and Radiological Health

FEDERAL CONTACT: Nardinelli, Clark
202-205-8702

PIC ID: 6865.2

PERFORMER: Research Triangle Park
Research Triangle Park, NC

EXPECTED DATE OF COMPLETION: 9/30/2000

Economic Cost Benefit Studies: Consumer Attitudes Toward Potential Changes in Food Standards of Identity

On December 29, 1995, the FDA announced its plan to review its regulations pertaining to identity, quality and container fill for standardized foods, and its common or usual name regulations for non-standardized foods. The agency solicited comments from interested parties on whether these regulations should be retained, revised, or revoked. The FDA solicited comments on the benefits or lack of benefits of such regulations in facilitating domestic and international commerce. The FDA also asked for comments on the value of these regulations to consumers, and on alternative means of accomplishing the statutory objective of food standards. This was done in an effort to promote honesty and fairness in the interest of consumers. The FSIS published a similar announcement regarding its intent to consider whether to modify or eliminate specific Standards on Identity for meat and poultry products, or to modify its overall regulatory approach to standardized meat and poultry products. The FDA and the FSIS need information on how consumers would be affected by changes in Federal Standards of Identity for foods. Most importantly, the two agencies need information on whether consumers would prefer particular elements of standards to be retained, modified, or eliminated for various types of food. (See PIC ID 6865.1, 6865.2)

AGENCY SPONSOR: Center for Food Safety and Applied Nutrition

FEDERAL CONTACT: Nardinelli, Clark
>202-205-8702

PIC ID: 6865

PERFORMER: Research Triangle Park
Research Triangle Park, NC

EXPECTED DATE OF COMPLETION: 9/30/2000

Food Contact Substance Procedures Team (FOCUS)

In November 1997, the OPA created the FOCUS team to reevaluate current procedures and recent streamlining efforts relating to the review process for food additive petitions for the approval of food contact substances. This group was also charged with the development of necessary procedures, plans, guidance, and regulations to implement the premarket notification process for food contact substances. Based on the work of this group, the OPA expects to announce revised guidance for premarket submissions for food contact substances in the first half of FY 1999. In addition, the OPA is currently developing the capability of incorporating Structure Activity Analysis (SAA) into the premarket review process for food contact substances and will continue training and process development in this area during FY 1999. Finally, during FY 1999, FOCUS will develop regulations required to implement the premarket notification process for food contact substances.

AGENCY SPONSOR: Center for Food Safety and Applied Nutrition

FEDERAL CONTACT: Rullis, Alan M.
202-418-3100

PIC ID: 7096

PERFORMER: Food and Drug Administration
Rockville MD

EXPECTED DATE OF COMPLETION: 9/30/2000

Food Labeling and Package Survey (FLAPS)

This survey was implemented by the Food and Drug Administration (FDA) in 1977 with the purpose of producing a database containing label and package information obtained from a sample of processed food products. Food Labeling and Packaging (FLAPS) data enable FDA personnel to keep abreast of market responses to food labeling rules via changes in package labels.

AGENCY SPONSOR: Center for Food Safety and Applied Nutrition

FEDERAL CONTACT: Benedict, Mary E
410-786-7724

PIC ID: 5711

PERFORMER: Food and Drug Administration
Rockville MD

EXPECTED DATE OF COMPLETION: 9/30/2000

Food Safety and Nutrition Evaluation Studies

AGENCY SPONSOR: Center for Food Safety and Applied Nutrition

FEDERAL CONTACT: Levy, Alan
202-205-9448

PIC ID: 7294

PERFORMER: Food and Drug Administration
Rockville, MD

EXPECTED DATE OF COMPLETION: 9/30/2000

Survey of Current Hazard Assessment Quality Control Points (HACCP) Practices of the Food Industry

This project consists of a two-part survey of current hazard assessment quality control points (HACCP) that will: (1) yield information for the purposes of estimating the HACCP-related practices of the food industry (except seafood, meat and poultry), and (2) estimate the marginal costs to firms for compliance with HACCP.

AGENCY SPONSOR: Center for Food Safety and Applied Nutrition

FEDERAL CONTACT: Nardinelli, Clark
202-205-8702

PIC ID: 6866

PERFORMER: Food and Drug Administration
Rockville MD

EXPECTED DATE OF COMPLETION: 3/2/2001

Medical Devices

FDAMA Mandated User Facility Reporting Program

The Food and Drug Modernization Act of 1997 (FDAMA) required FDA's Center for Radiological Health (CDRH) to change its user facility program from universal, mandated reporting of adverse events to a program of user reporting limited to certain facilities, constituting a representative profile. Although the 1992 amendments to the Safe Medical Device Act required reporting of all events causing serious injury or death due to medical devices, FDA did not have the resources or personnel to monitor the 40,000 to 50,000 user facilities involved. Thus, the FDAMA called for a solution to this problem by asking the FDA to establish a sentinel surveillance system by identifying a sample of facilities and a more proactive surveillance network among them. Congress also required the agency to submit a progress report by late 1999 on efforts towards implementing the new sentinel system. This project has been instrumental in assessing the feasibility and effectiveness of such a reporting program.

AGENCY SPONSOR: Center for Devices and Radiological Health

FEDERAL CONTACT: Gardner, Susan
301-594-2812

PIC ID: 7108

PERFORMER: Food and Drug Administration
Rockville MD

EXPECTED DATE OF COMPLETION: 9/30/2000

Nationwide Evaluation of X-Ray Trends (NEXT)

The Nationwide Evaluation of X-Ray Trends (NEXT) is a collaborative program conducted jointly between the Food and Drug Administration (FDA) and State radiation control agencies. The study estimates the radiation dosage from diagnostic x- ray examinations, using data collected from previous NEXT surveys of different types of x-ray examinations. The data are used by public health and professional organizations in setting policy.

AGENCY SPONSOR: Center for Devices and Radiological Health

FEDERAL CONTACT: Suleiman, Orhan
301-594-3533

PIC ID: 4984

PERFORMER: Food and Drug Administration
Rockville MD

EXPECTED DATE OF COMPLETION: 9/30/2000

Toxicological Research

An Evaluation of Dietary Fibers for the Prevention of Mammary Cancer in Female Rats

Recently passed laws have allowed food industries to label products containing added fiber with health claims. This proposed study will identify which type (and dietary level) of fiber would be of potential benefit for preventing or reducing breast cancer in women. The study will also provide FDA a scientific basis for making regulatory decisions concerning health-effect labels on fiber-rich products.

AGENCY SPONSOR: Food and Drug Administration

FEDERAL CONTACT: Jackson, Carlton
870-543-7553

PIC ID: 7114

PERFORMER: Food and Drug Administration
Rockville MD

EXPECTED DATE OF COMPLETION: 9/30/2000

Caloric Intake and Human Health (The NHANES-1 Study)

The objective of this study is to determine whether caloric consumption is a predictor of human health in general, or of certain specific health effects. The study will provide answers to questions concerning food intake and health, and in particular, issues addressing the correlations between caloric intake, weight, obesity and health risk.

AGENCY SPONSOR: National Center for Toxicological Research

FEDERAL CONTACT: Freni, Stan
870-543-7517

PIC ID: 7110

PERFORMER: Food and Drug Administration
Rockville MD

EXPECTED DATE OF COMPLETION: 9/30/2000

Veterinary Medicine

Electronic Submissions to CVM via the Internet

This study is part of a larger ongoing initiative to submit information to the Center electronically. CVM started receiving electronic submissions of Notices of Investigation Exemptions (NCIEs) during September 1997 on a pilot basis with a limited number of drug sponsors. Performance during the pilot period was evaluated and showed that processing time for electronic submissions was reduced to a third of that for comparable paper submissions before the pilot. As a result, in 1999 the Center released guidance allowing any registered sponsors to submit information in electronic format through e-mail. The advantages of this new system included: reduction in transmittal time from the sponsor to the Center, reduced processing time within the Center, reduced paper handling and storage requirements, increased customer satisfaction, and the ability of the Center to review, process, store and retrieve electronic records. The Center is preparing guidance documents to expand the scope of the electronic transmission process to include other reporting requirements. A report of this endeavor appears on FDA's home page under the electronic submissions section.

AGENCY SPONSOR: Center for Veterinary Medicine

FEDERAL CONTACT: Parbuoni, Elizabeth
301-827-7562

PIC ID: 7288

PERFORMER: Food and Drug Administration
Rockville MD

EXPECTED DATE OF COMPLETION: 9/30/2000

Organization Study on Bioresearch Monitoring (BIMO) Activities at the Center for Vet. Medicine and the Relationship of Quality Assurance as a Function. of the BIMO Program.

The objective of this study was to review and evaluate current bioresearch monitoring (BIMO) functions and recommend changes, if appropriate, and determine the correlation between the Quality Assurance/Quality Control responsibilities of drug sponsors and the BIMO program. The report recommends actions to consider (such as timeliness of inspections) for improving the Center for Veterinary Medicine's (CVM's) existing BIMO program. With the possible exception of expanding the BIMO staff, the recommendations may be accomplished by using the Center's current resources. The report also presents a plan whereby the Office of Surveillance and Compliance and the Office of New Animal Drug Evaluation can make the BIMO program more efficient and relevant to the review process by providing as many tools as possible (especially to the reviewers) through center-wide access to BIMO information.

AGENCY SPONSOR: Center for Veterinary Medicine

FEDERAL CONTACT: Larkins, Marcia
301-827-0137

PIC ID: 7271

PERFORMER: Food and Drug Administration
Rockville MD

EXPECTED DATE OF COMPLETION: 9/30/2000

Health Care Financing Administration

MISSION: To promote the timely delivery of appropriate, quality health care to the Nation's aged, disabled, and poor through administration of the Medicare and Medicaid programs.

Evaluation Program

The research arm of the Health Care Financing Administration (HCFA), the Office of Strategic Planning (OSP), performs and supports research and evaluations of demonstrations (through intramural studies, contracts and grants) to develop and implement new health care financing policies and to provide information on the impact of HCFA's programs. The scope of OSP's activities embraces all areas of health care: costs, access, quality, service delivery models, and financing approaches. OSP's research responsibilities include evaluations of the ongoing Medicare and Medicaid programs and of demonstration projects testing new health care financing and delivery approaches. These projects address the following major themes:

· Medicare Health Plans: Enrollment, Delivery, and Payment--Highlights of these research, demonstration and evaluation (RD&E) efforts include research demonstrating favorable selection in enrollment, the development of systems for measuring beneficiary risk that can be used for refining capitated payments, and demonstrations that have tested and evaluated the effectiveness of a wide range of capitated health plan arrangements.

Provider Payment and Delivery Innovations in Traditional Fee-for-Service Medicare--Current RD&E projects include attempts to better align providers' incentives to deliver cost-effective care, either through payment innovations such as bundled payment models or prospective payment systems for post-acute care. Other initiatives include competitive bidding and experiments to foster coordinated care.

Research on the Future of Medicare--HCFA requires more information in order to assess the impact of longer term structural reforms of the Medicare program necessary to deal with the dramatic increase in the number of beneficiaries. Analyses to support the development of proposals for Medicare reform for congressional consideration will be required. In addition, it is anticipated that there will be a need for demonstration and evaluation activities related to future of Medicare reform.

Outcomes, Quality and Performance--HCFA's RD&E agenda involves the development and testing of improved information resources that will enable consumers to choose among health plans and providers based on their relative value and quality. One part seeks to better understand how choices are made so that beneficiaries can use information most effectively. The complementary part of the agenda aims to develop better tools for measuring health care outcomes and quality, as well as the performance of heOutcomes, Quality and Perfo

Vulnerable Populations and Dual Eligibles--A special focus of projects in this area is the demonstration of coordinated care models that integrate the range of services available to persons dually eligible for Medicare and Medicaid. Development of a risk adjustment system that would support capitated payment for dual eligibles is a key element related to this activity.

State Programs--This demonstration authority is used to provide expanded eligibility or additional services to individuals. In return for greater flexibility, States commit to a policy experiment that can be evaluated.

Research & Development Support Services--HCFA's research budget supports a variety of activities to increase the efficiency of our research and demonstration program and meet the crosscutting research needs of HCFA and the wider health research community.

Fiscal Year 1999 Evaluation Reports

Cross-Cutting

Implementing State Health Care Reform: What Have We Learned From the First Year? The First Annual Report of the Evaluation of Health Reform in Five States

This project provided initial State-specific and cross-State analyses of demonstration impacts on utilization, insurance coverage, public and private expenditures, quality, access and satisfaction. Analyses of all groups is, where possible, stratified by age, income, geographic location, and other relevant demographic variables. Data come from site visit interviews with providers, advocacy groups, and State officials, participant surveys, hospital discharge data, and secondary data sources such as the area resource file and current population survey. During 1996, two important design and funding additions were made to the project: (1) examination of the impacts on the disabled; and (2) assessment of the impacts on mental health and substance abuse service users.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Pine, Penny
410-786-7718

PIC ID: 6289

PERFORMER: Mathematica Policy Research, Inc.
Plainsboro, NJ

Managed Care

HCFA On-Line: Market Research for Providers--Final Focus Group Report on the Managed Care Module

This report describes findings from focus group meetings with Health Maintenance Organizations (HMOs) held to help inform HCFA about: (1) what information managed care plans and providers need and want, and (2) how such information can most effectively be provided. This report summarizes common issues/themes which emerged and provides insight about the following key questions: (1) How do HMO communications with HCFA compare to and contrast with their communications with the plan's largest group purchaser (or other group with which the HMO regularly communicates)?; (2) What new information would HMOs like to receive from HCFA; (3) What sources do HMOs rely on to get information about Medicare?; (4) How would HMOs like to receive information from HCFA?; (5) What are HMOs' general experiences in communication with HCFA representatives? and (6) What one recommendation to HCFA would HMOs make to improve HCFA's communications? In general, HMOs indicated a desire to work more collaboratively with HCFA and to increase opportunities for HMOs to communicate with HCFA. According to focus group participants, improvements in communications are needed to clarify HCFA's message and to ensure the consistency and timeliness of communications. (See PIC ID 6921)

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Terrell, Sherry
410-786-6601

PIC ID: 6921.1

PERFORMER: Westat, Inc.
Rockville, MD

Medicare

1999 Annual Data Report (ADR) of the USRDS

This 1999 Annual Data Report US Renal Data System (USRDS) updates last year's analysis of 1) the economic cost of End- Stage Renal Disease (ESRD), 2) Medicare spending for different treatment modalities, and 3) Medicare spending by physician speciality and supplier type (e.g., medical supply company, ambulance, laboratory). Data are reported through the end of 1997. In addition to updating previously reported information, data on the interstate variation of Medicare spending are reported for the first time. The results are reported in four sections of Chapter X, entitled, "The Economic Cost of ESRD and Medicare Spending for Alternative Modalities of Treatment." Previous annual data reports were issued from 1994-1998 and can be downloaded from the USRDS web site: http://www.usrds.org.

AGENCY SPONSOR: Health Care Financing Administration

FEDERAL CONTACT: Greer, Joel
410-786-6695

PIC ID: 7198.1

PERFORMER: National Institute of Diabetes and Digestive and Kidney Diseases
Bethesda, MD

Evaluation Plan for the Medicare-DoD Subvention Demonstration

This evaluation plan describes the Medicare-DoD Subvention demonstration mandated by Section 4015 of the Balanced Budget Act of 1997. It examines issues involved in implementing the programs encompassed and presents RAND's planned approach to perform the evaluation. The plan describes how HCFA will assess the impact of the demonstration on government costs and effects on enrollees, other Medicare or DoD beneficiaries, military treatment facilities, TRICARE Lead Agents and contractors, and other stakeholders. The planned evaluation will generate operational information and "lessons learned" from sites' implementation experiences. It will conduct site visits, focus groups and interviews, analyze eligible population and enrollment data, review payment and cost data and results of several DoD Surveys of retirees and of military treatment facility patients.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Greenwald, Leslie M., Ph.D.
410-786-6502

PIC ID: 7171.1

PERFORMER: Rand Corporation
Santa Monica, CA

Interim Report: Evaluation of the Medicare-DoD Subvention Demonstration

This report presents early results from RAND's evaluation of the Medicare-DoD subvention demonstration, established by the Balanced Budget Act of 1997 to implement cost-effective alternatives for care for those eligible for both Medicare and military retiree health benefits while ensuring that total federal costs for either the Health Care Financing Administration (HCFA) or the Department of Defense (DoD) are not increased. This phase of the demonstration began to examine implications for establishing Senior Prime as a permanent part of the TRICARE program. (See also PIC ID numbers 7171 and 7171.1) TRICARE Senior Prime established Medicare+Choice health plans operated by DoD, under contract with HCFA in six demonstration sites. Senior Prime enrollees chose a military primary care manager at a participating military treatment facility (MTF) to receive their primary care and other services there. For any services not provided by the MTF, enrollees were referred to other MTFs or to civilian providers under contract to the Senior Prime network, depending on facility proximity and enrollee choice. Because this demonstration had only been underway for 6 to 10 months, depending on the site, it was too early to assess the effects of Senior Prime on dual-eligible beneficiaries or on government costs. This study includes preliminary assessments of the following activities involved in the initial phase of Senior Prime implementation: obtaining Medicare certification for the plans, marketing and enrolling beneficiaries, enrollee intake and initial service delivery, and managing and monitoring plan performance.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Greenwald, Leslie
410-786-6502

PIC ID: 7171.2

PERFORMER: Rand Corporation
Santa Monica, CA

Minimal-Burden Risk Adjusters for the Medicare Risk Program

Studies have shown that payments to risk plans under the Medicare program exceed the cost that HCFA would have incurred under traditional fee-for-service (FFS) Medicare. The overpayment occurs because the mechanism for setting the capitation rates that risk plans are paid for providing coverage of Medicare services fails to reflect health status adequately. HCFA funded this study, among others, to develop more effective risk adjusters for the general Medicare population. This project developed a risk adjuster that is based on 1) a history of serious disease (including cancer, heart disease or stroke) and severity of illness; 2) the length of time since the last hospital stay; and (3) comorbidities. The predictive power from using history of serious illness was compared to the predictive power of two existing risk adjusters--the diagnostic-cost group and ambulatory-care group models. Both predictive accuracy and operational features were compared.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Levy, Jesse
410-786-6600

PIC ID: 7190

PERFORMER: Virginia Commonwealth University
Richmond, VA

The Kansas City Evaluation of "Medicare and You (1999)" and "Medicare CAHPS": Results from Focus Groups with Aged, Disabled, and Dual Eligible Beneficiaries

The purpose of this study is to evaluate new Medicare consumer information materials, i.e., the "Medicare and You" handbook (1999) and the "Medicare CAHPS" report. This describes the main findings from seven focus groups conducted with aged, disabled, and beneficiaries dually eligible for Medicare and Medicaid (56 participants) in Kansas City, Kansas and in Missouri. The goal of the focus groups was to learn what Medicare beneficiaries though about the handbook (1999) and the report, and whether the information helped them to decide about a health plan. Beneficiaries generally believe that the handbook is: (1) comprehensive and understandable, (2) more useful as a reference tool than as a decision tool, and (3) more trustworthy than information from managed care plans. Beneficiaries also responded favorably to the CAHPS report. They believed that the CAHPS report is relevant primarily for people considering membership in an HMO. The level of trust in the report was mixed, e.g., some believed the report was intended to encourage people to join an HMO or that it was marketing material from a particular HMO. In summary, the focus group findings reflect well on both the "Medicare and You" handbook and the "Medicare CAHPS" report. Most beneficiaries understood the main messages of each booklet.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Terrell, Sherry
410-786-6601

PIC ID: 7168

PERFORMER: Research Triangle Park
Research Triangle Park, NC

Quality of Care

The Case Identification Challenge in Measuring Performance in Breast Cancer Care

It may not be difficult to realize the importance of valid measures of the performance of medical providers, groups, and plans, however, the challenges of valid performance measurement are not as easily understood. The purpose of this paper is to inform and assist cancer care providers' responses to these challenges by clarifying the issues critical to one area of performance measurement, case identification, and recommending possible strategies for handling these issues. Case identification is an important and complex undertaking. Registry rapid case ascertainment has considerable potential for accurately producing the information needed. Performance measurement researchers would be well-advised to work closely with cancer registry officials to realize this potential. Improving the understanding of critical steps in case identification across health services research, clinical settings, pathology laboratories, registries, and hospital management is likely to generate more valid data at lower costs, data which can be used with confidence to assess and improve care delivered to patients with breast cancer.

AGENCY SPONSOR: Health Care Financing Administration

FEDERAL CONTACT: Abel-Steinberg, Benedicta
410-782-3104

PIC ID: 7239

PERFORMER: Rand Corporation
Santa Monica, CA

In-Progress Evaluations

Child Health Insurance

Evaluation of the Child Health Insurance Program

The State Children's Health Insurance Program (SCHIP) established by the Balanced Budget Act (BBA) in 1997 is designed to provide medical coverage for children under age 19 who are not eligible for Medicaid and with family incomes below 200 percent of the Federal poverty level or 50 percentage points above the current State Medicaid limit. States are required to examine and track the impact of SCHIP in reducing the numbers of low-income uninsured children. This project will involve a summary and analysis of the State evaluations and an analysis of external SCHIP-related activities. It will provide an analysis of the effect of SCHIP on enrollment expenditures and use of services in Medicaid and State health programs, and an evaluation of stand-alone and Medicaid expansion programs, including the effectiveness of their outreach activities and the quality of care.

AGENCY SPONSOR: Health Care Financing Administration

FEDERAL CONTACT: Hakim, RoseMarie
410-786-6698

PIC ID: 7380

PERFORMER: Mathematica Policy Research, Inc.
Washington, DC

EXPECTED DATE OF COMPLETION: 07/13/2004

Cross-Cutting

Economic and Cost-Effectiveness Studies from the U.S. Renal Disease Data System

This interagency agreement (IAA) provided funds to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) to cover the costs of having the coordinating center for the U.S. Renal Data System (USRDS) perform economic and cost-effectiveness studies. The NIDDK contracted with the University of Michigan to be the coordinating center for 5 years. The coordinating center conducts cost or cost-effectiveness components for at least four existing data studies and for one special study focused on economic issues.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Greer, Joel
410-786-6695

PIC ID: 7198

PERFORMER: National Institute of Diabetes and Digestive and Kidney Diseases
Bethesda, MD

EXPECTED DATE OF COMPLETION: 09/30/2000

Maximizing the Effective Use of Telemedicine: A Study of the Effects, Cost Effectiveness, and Utilization Patterns of Consultation via Telemedicine

This project is conducting an evaluation of the Health Care Financing Administration's (HCFA's) medicare payment demonstration. The evaluation examines the medical effectiveness, patient and provider acceptance, and costs associated with telemedicine services, as well as their impact on access to care in rural areas.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Greer, Joel
410-786-6695

PIC ID: 6303

PERFORMER: Center for Health Policy Research
Denver, CO

EXPECTED DATE OF COMPLETION: 09/28/2002

Multi-State Evaluation of Dual Eligibles Demonstrations

This evaluation is designed to assess the impact of dual eligible demonstrations in the States of Minnesota, Colorado, Wisconsin and New York. Analyses will be conducted for each State and across States.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Rudolph, Noemi
410-786-6662

PIC ID: 7186

PERFORMER: University of Minnesota
Minneapolis, MN

EXPECTED DATE OF COMPLETION: 09/29/2002

Performance Assessment of Web Sites

This task order: (1) evaluates, (2) sets up an ongoing system for feedback from consumers, and (3) makes recommendations for future changes concerning two web sites sponsored by the Department of Health and Human Services. The web sites include www.medicare.gov, which was developed by the Health Care Financing Administration (HCFA), and www.healthfinder.gov, which was developed by the Office of Disease Prevention Health Promotion in collaboration with other agencies.

AGENCY SPONSOR: Center for Beneficiary Services

FEDERAL CONTACT: Crawley, Barbara
410-786-6590

PIC ID: 7212

PERFORMER: Barents Group, KPMG Peat Marwick LLP
Washington, DC

EXPECTED DATE OF COMPLETION: 04/30//2000

Home Health Care

Evaluation of Phase II of the Home Health Agency Prospective Payment Demonstration

This demonstration is testing two alternative methods of paying home health agencies (HHA) on a prospective basis for services furnished under the Medicare program: (1) per visit by type of HHA visit discipline (Phase I), and (2) payment per episode of Medicare-covered home health care (Phase II). The evaluation will combine estimates of program impacts on cost, service use, access and quality, with detailed information on how agencies actually change their behavior to produce a full understanding of what would happen if prospective payment replaced the current cost-based reimbursement system nationally.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Meadow, Ann
410-786-6602

PIC ID: 7203

PERFORMER: Mathematica Policy Research, Inc.
Washington, DC

EXPECTED DATE OF COMPLETION: 09/30/2002

Maximizing the Cost Effectiveness of Home Health Care

Rapid growth in home health use has occurred despite limited evidence about the necessary volume of HHC needed to achieve optimal patient outcomes, and whether or not it substitutes for more costly institutional care. The central hypotheses of this study are that: (1) volume-outcome relationships are present in HHC for common patient conditions, (2) upper and lower volume thresholds define the range of services most beneficial to patients, and (3) a strengthened physician role and better integration of HHC with other services during an episode of care can optimize patient outcomes while controlling costs.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Meadow, Ann
410-786-6602

PIC ID: 7179

PERFORMER: Center for Health Policy Research
Denver, CO

EXPECTED DATE OF COMPLETION: 09/30/2000

Managed Care

Decision Making in Managed Care Organizations

This project examines a broad range of managed-care decision making strategies, their implications for the development and diffusion of new technologies, and their impact on future health care costs, especially Medicare program costs.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Goody, Brigid
410-786-6640

PIC ID: 7170

PERFORMER: Health Economics Research, Inc.
Waltham, MA

EXPECTED DATE OF COMPLETION: 04/28/2000

Evaluation of Group-Specific Volume Performance Standards Demonstration

The goal of the demonstration is to test the feasibility of this partial risk bearing payment arrangement between the Health Care Financing Administration and qualifying physician-based organizations in the fee-for-service (FFS) market. FFS rules apply within the context of a performance target, beneficiaries are not enrolled, and physician-sponsored organizations develop structures and processes to manage the services and cost of care received by FFS patients.

AGENCY SPONSOR: Center for Health Plans & Providers

FEDERAL CONTACT: Mason, Cynthia K.
410-786-6680

PIC ID: 7181

PERFORMER: Health Economics Research, Inc.
Waltham, MA

EXPECTED DATE OF COMPLETION: 06/01/2001

Medicaid

Evaluation of Oregon Medicaid Reform Demonstration

The Oregon Medicaid Reform Demonstration seeks to increase the number of individuals with access to affordable health care services and to contain State and Federal expenditures for health care. Under the demonstration, Medicaid coverage is made available to all State residents with family incomes less than, or equal to, the Federal poverty level (FPL) and who meet an assets test. The objectives of the evaluation are to determine the impact on: (1) access to care, (2) quality of care, (3) enrollee satisfaction, and (4) the cost of care, for both new enrollees and those previously enrolled in Medicaid. To the extent possible, the impact of the prioritized list and the increased use of managed care will be identified separately. Other areas of interest include: (1) the impact of the demonstration on the number of uninsured in the State, (2) provider participation and satisfaction, and (3) the number of private employers who offer health insurance as a fringe benefit.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Boben, Paul J., Ph.D.
410-786-6629

PIC ID: 6166

PERFORMER: Health Economics Research, Inc.
Waltham, MA

EXPECTED DATE OF COMPLETION: 12/31/2000

Evaluation of the Diamond State Health Plan

The original purpose of this project was to evaluate the Delaware Health Care Partnership for Children, specifically the effectiveness of the demonstration in reaching its goal of improving access to, and the quality of, health care services delivered to Medicaid-eligible children in a cost-effective way. In May 1996, the contract was modified to focus more generally on the impacts of the Diamond State Health Plan (DSHP) on children, including children with special health care needs (the original evaluation had been limited to the Nemours Children's Clinics). The goal of the evaluation was broadened to assess whether this section 1115 demonstration's objective of increased access to high-quality, cost-effective care for Medicaid children is being met.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Pine, Penny
410-786-7718

PIC ID: 6288

PERFORMER: Research Triangle Park
Research Park, NC

EXPECTED DATE OF COMPLETION: 12/30/2000

Evaluation of the Home & Community-Based Services Waiver Program

The Home and Community-Based Services (HCBS) waiver program has been operating since 1981 and has experienced tremendous growth in recent years. The percent of Medicaid long-term care spending devoted to HCBS has increased from 10 percent to 19 percent (between the financial and beneficiary-level impacts of the program) in over a decade. The aim of this task order is to gain a better understanding of the broader HCBS waiver program and determine what programmatic mechanisms have been successful.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Mentnech, Renee
410-786-6692

PIC ID: 7208

PERFORMER: The Lewin Group
Fairfax, VA

EXPECTED DATE OF COMPLETION: 03/29/2002

Evaluation of the Ohio Behavioral Health Program

This project will address the following two components: (1) a focused evaluation of the behavioral health component of OhioCare, and (2) a case study of the implementation of Ohio's section 1115 State health reform demonstration, OhioCare. The case study will complement the focused evaluation by providing a context for findings and supplementing findings.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Pine, Penny
410-786-7718

PIC ID: 7184

PERFORMER: Health Economics Research, Inc.
Waltham, MA

EXPECTED DATE OF COMPLETION: 09/14/2001

Evaluation of the State Health Reform Demonstrations (OH, MN)

This project will evaluate Hawaii, Rhode Island, Tennessee, Oklahoma and Maryland State Health Reform Demonstrations. The evaluator is conducting State-specific and cross-State analyses of demonstration impacts on utilization, insurance coverage, public and private expenditures, quality, access and satisfaction.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Pine, Penny
410-786-7718

PIC ID: 6289.1

PERFORMER: Urban Institute
Washington, DC

EXPECTED DATE OF COMPLETION: 09/30/2002

Impact of Welfare Reform on Medicaid Populations

This project will develop data and examine the impact of welfare reform on Medicaid eligibility, utilization and payments for various populations. It will study the effects of the following four changes: (1) de-linking Aid to Families with Dependent Children (AFDC) and Medicaid eligibility, (2) terminating access to Medicaid for some legal immigrants because of lost eligibility for Supplementary Security Income (SSI), (3) barring most future legal immigrants from Medicaid, and (4) narrowing Medicaid eligibility for selected disabled children and disabled alcohol and substance abuse populations.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Pine, Penny
410-786-7718

PIC ID: 7183

PERFORMER: Mathematica Policy Research, Inc.
Washington, DC

EXPECTED DATE OF COMPLETION: 09/29/2001

Project Demonstrating and Evaluating Alternative Methods to Assure and Enhance the Quality of Long-Term Care Services for Persons with Developmental...

This task order will develop and validate a comprehensive set of performance measures and indicators of quality for institutional post-acute and long-term care settings. The post-acute settings involved are: SNF short-stay units, inpatient rehabilitation facilities (which include hospital-based rehabilitation units) and long-term care hospitals.

AGENCY SPONSOR: Ctr. for Medicaid & State Operations

FEDERAL CONTACT: Greenberg, David
410-786-2637

PIC ID: 6310

PERFORMER: Abt Associates, Inc.
Cambridge, MA

EXPECTED DATE OF COMPLETION: 09/29/2002

Medicare

Department of Defense Subvention Demonstration Evaluation

Under this demonstration, enrollment in the Department of Defense's (DoD's) Senior Prime plan is offered to military retirees over age 65 who live within 40 miles of the primary care facilities of one of the six sites, have recently used military health facility services and are enrolled in Medicare Part B. Medicare makes a capitation payment to the DoD for each enrollee, but the DoD must maintain a level of effort for health care services to all retirees who are also Medicare beneficiaries, whether or not they choose to enroll. The evaluation will examine issues in four basic areas: (1) enrollment demand, (2) enrollee benefits, (3) cost of the program, and (4) impacts on other DoD and Medicare beneficiaries. See PIC ID 7171.1.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Greenwald, Leslie M., Ph.D.
410-786-6502

PIC ID: 7171

PERFORMER: Rand Corporation
Santa Monica, CA

EXPECTED DATE OF COMPLETION: 03/02/2002

Evaluation of CAHPS/Bulletin/Medicare and You in Kansas City MSA

A consortium of organizations in Kansas and Missouri agreed to participate in an Agency for Healthcare Research and Quality (AHRQ) test of a health plan quality assessment system--the Consumer Assessment of health Plans Study (CAHPS) report. The report is designed to examine consumer quality ratings about local managed care plans' performance. HCFA joined AHRQ and the coalition to extend the evaluation from private plan enrollees and Medicaid enrollees to the Medicare population in Kansas City Metropolitan Statistical Area (MSA). The purpose of this study is to learn whether Medicare beneficiaries use comparative quality information to make health plan choices and whether the Medicare information program (print material) is effective.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Terrell, Sherry
410-786-6601

PIC ID: 7168.1

PERFORMER: Research Triangle Institute
Box 12194, Research Triangle Park, NC 27707-2194

EXPECTED DATE OF COMPLETION: 12/31/2000

Evaluation of Competitive Bidding Demonstration for DME and POS

This project will test the feasibility and effectiveness of establishing Medicare fees for durable medical equipment (DME) and Prosthetics, Prosthetic devices, Orthotics and supplies (POS) through a competitive bidding process. The evaluation will examine competitive bidding impacts in terms of expenditures, quality, access and product diversity, as well as other impacts of the demonstration.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Meadow, Ann
410-786-6602

PIC ID: 7173

PERFORMER: University of Wisconsin
Madison, WI

EXPECTED DATE OF COMPLETION: 05/15/2003

Evaluation of QMB and SLMB Programs

This project is designed to evaluate quantitatively and qualitatively the Qualified Medicare Beneficiary (QMB) and the Specified Low-Income Medicare Beneficiary (SLMB) Programs in the following areas: (1) the motivations and perceptions of enrollees and non enrollees, (2) reasons for state variation in enrollment patterns, (3) the impact of enrollment on Medicare and Medicaid costs and service use, and (4) the impact of enrollment on out-of-pocket costs of eligible individuals. Primary data collection activities will include: a survey of a national sample of QMB and SLMB enrollees and of eligible non- enrollees, focus groups of enrollees and non-enrollees, a survey of state agencies, and case study interviews with officials from agencies and advocacy groups. Secondary data sources include: the Medicare Current Beneficiary Survey, the Medicare National Claims History file, the Medicaid Statistical Information System, Third party Buy-In file, and the Medicare Enrollment Database. Descriptive and multivariate analyses will be conducted with the primary and secondary data.

AGENCY SPONSOR: Health Care Financing Administration

FEDERAL CONTACT: Rudolph, Noemi
410-786-6662

PIC ID: 7390

PERFORMER: Health Economics Research, Inc.
Waltham, MA

EXPECTED DATE OF COMPLETION: 12/14/2002

Evaluation of the Community Nursing Organization (CNO) Demonstration

This demonstration tests a capitated, nurse-managed system of care. The two fundamental elements of the CNO are capitated payment and nurse case management. The evaluation tests the feasibility and effect on patient care of this capitated, nurse case-managed service delivery model. Both qualitative and quantitative components are included.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Hawthorne, James
410-786-6689

PIC ID: 6306.1

PERFORMER: Abt Associates, Inc.
Cambridge, MA

EXPECTED DATE OF COMPLETION: 12/31/1999

Evaluation of the Evercare Demonstration Program

The major goals of the Evercare demonstration are to reduce medical complications and dislocation trauma resulting from hospitalization, and to save the expense of hospital care when patients can be managed safely in nursing homes with expanded services. The EverCare evaluation will combine data from site case studies, a network analysis of nurse practitioners, participant and caregiver surveys and participant utilization data to examine: (1) a comparison of enrollees and non-enrollees; (2) the process of implementation and operation of EverCare changes in the care process, as well as quality of care; (3) effects of the demonstration on enrollees' health and health care utilization; (4) satisfaction of enrollees and their families; and (5) effects of the demonstration on the costs of care, as well as payment sources.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Greenwald, Leslie M., Ph.D.
410-786-6502

PIC ID: 7185

PERFORMER: University of Minnesota
Minneapolis, MN

EXPECTED DATE OF COMPLETION: 03/30/2001

Evaluation of the Medical Savings Account Demonstration

This evaluation of the Medical Savings Account (MSA) demonstration will compare the experiences of MSA enrollees with other Medicare beneficiaries. The evaluation will address access to care and determine if MSAs promote an inappropriately low use of services.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Mentnech, Renee
410-786-6692

PIC ID: 7172

PERFORMER: Barents Group, KPMG Peat Marwick LLP
Washington, DC

EXPECTED DATE OF COMPLETION: 09/27/2003

Evaluation of the Medicare Choice Demonstration

The HCFA is in the process of implementing the Medicare Choice Demonstration to test the feasibility and desirability of new types of managed care plans for Medicare, such as integrated delivery systems and preferred provider organizations. The purpose of this evaluation project is to provide a detailed assessment of the overall demonstration project, which looks specifically at beneficiary experiences in the demonstration, cost and use of services within the demonstration sites and quality of care issues.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Mentnech, Renee
410-786-6692

PIC ID: 6292

PERFORMER: Mathematica Policy Research, Inc.
Plainsboro, NJ

EXPECTED DATE OF COMPLETION: 09/30/2000

Evaluation of the New York Medicare Graduate Medical Education Payment Demonstration and Related Provisions

Medicare's annual graduate medical education (GME) spending reached $7 billion, of which nearly 20 percent was for New York teaching hospitals. This is a coordinated evaluation of a major demonstration which provided incentives for New York State teaching hospitals to reduce their residencies by 20 to 25 percent over a 5-year period, and several provisions of the Balanced Budget Action of 1997 (BBA) which were also aimed at reducing Medicare GME spending. The evaluation assessed the impacts of residency reduction on access to service delivery as well as the economic and workforce effects. This is a follow-on project to the design effort; thus, the work is being performed in the manner described in the "Design for Evaluation of the New York Medicare GME Demonstration and Related Provisions in P.L. 105-330 (BBA): Recommended Design and Strategy for NY GME Demonstration and National BBA GME Provisions." The project will present a series of reports.

AGENCY SPONSOR: Health Care Financing Administration

FEDERAL CONTACT: Buczko, William
410-786-6593

PIC ID: 7379

PERFORMER: Health Economics Research, Inc.
Waltham, MA

EXPECTED DATE OF COMPLETION: 09/29/2004

Evaluation System for Medicare + Choice

The purpose of this task order is to design and implement a strategy for tracking and evaluating the performance of managed health care organizations, both nationwide and within specific markets. Dimensions of performance to be tracked include beneficiary access to managed care, as well as the cost and quality of services delivered to beneficiaries by managed care organizations.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Goody, Brigid
410-786-6640

PIC ID: 7169

PERFORMER: Mathematica Policy Research, Inc.
Washington, DC

EXPECTED DATE OF COMPLETION: 09/15/2001

Expanded Evaluation of Medicare and You Handbook: 2000

The purpose of this project is to establish national measures of Medicare beneficiaries' knowledge of the basic Medicare program and their understanding of new Medicare+Choices available under the Balanced Budget Act of 1997. The program objective is to evaluate National Medicare Education Program (NMEP) print material (Handbook 2000) and selected information distribution channels (i.e., print, Internet, 1-800-MEDICARE) using the knowledge index. The policy objectives of this project are to support HCFA strategic plan initiatives, contribute to Government Performance and Results Act program performance reporting, and provide feedback for monitoring and continuous quality improvement of NMEP informational materials directed to the Medicare population over time.

AGENCY SPONSOR: Health Care Financing Administration
FEDERAL CONTACT: Terrell, Sherry
410-786-6601

PIC ID: 7393

PERFORMER: Research Triangle Park
Research Park, NC

EXPECTED DATE OF COMPLETION: 05/09/2000

NAS/Institute of Medicine Study on Preventive Services

This is an analysis of the expansion or modification of preventive or other services covered by Medicare. The study includes coverage of: (1) nutrition therapy, including parenteral and enteral nutrition; (2) skin cancer screening; (3) medically necessary dental care; (4) routing patient care costs for beneficiaries enrolled in approved clinical trial programs; and (5) elimination of time limitation for coverage of immunosuppressive drugs for transplant patients. The IOM will consider both short-term and long-term benefits and costs to the Medicare program.

AGENCY SPONSOR: Office of Clinical Standards & Quality

FEDERAL CONTACT: Pirotte, Kathy
410-786-6774

PIC ID: 7174

PERFORMER: National Academy of Sciences
Washington, DC

EXPECTED DATE OF COMPLETION: 02/28/2000

Normative Standards for Medicare Home Health Utilization

This task order will develop a model that uses scientifically based, normative standards to determine thresholds for payment authorization within home health service categories, and will test the model to determine the extent of its validity and reliability. The contractor will also recommend an appropriate demonstration design to evaluate the use of the model by fiscal intermediaries prior to full implementation.

AGENCY SPONSOR: Office of Clinical Standards & Quality

FEDERAL CONTACT: Wheeler, Mary
410-786-6892

PIC ID: 7175

PERFORMER: Center for Health Policy Research
Denver, CO

EXPECTED DATE OF COMPLETION: 09/24/2000

Survey and Evaluation of New Medicare Members of Medicare+Choice Plans

The purpose of this project is to design a survey for and collect data from Medicare beneficiaries who are new members of Medicare+Choice (M+C) plans and to evaluate the effectiveness of the National Medicare Education Program (NMEP) for these beneficiaries. The objective is to understand the special information needs of new Medicare members, their sources of information (who/where), their preferred distribution channels (how), their understanding of the basic (standard) Medicare program, their understanding of their particular M+C plan, and the impact NMEP activities may have on new members' decision to choose an M+C plan or change their plan. This project does not include the disenrollee population. The project will support HCFA strategic plan initiatives, contribute to Government Performance and Results Act program performance reporting, and provide feedback for monitoring and quality improvement to NMEP informational materials directed to the M+C population over time.

AGENCY SPONSOR: Health Care Financing Administration

FEDERAL CONTACT:

PIC ID: 7392

PERFORMER: Mathematica Policy Research, Inc.
Washington, DC

EXPECTED DATE OF COMPLETION: 09/07/2001

Quality of Care

Comparison of Pharmaceutical Quality of Care for Pediatric Asthma

This project examined the quality of care in the treatment of asthma in Medicaid children in Alabama and Michigan. It assessed the extent of prescribing problems for pediatric asthma in these Medicaid programs. The study first examined whether asthma medication regimes for children covered by Medicaid were in compliance with the recommendations made by the NIH consensus National Asthma Education Project in 1991. The findings indicate that asthma care provided in urgent- oriented settings is not conducive to on-going, appropriate, prevention-oriented treatment of the condition. Secondly, the study assessed the utility of claims data for measuring the quality of asthma care. Generally, claims accurately represented what occurred during an encounter, but did not accurately identify all of the cases where a diagnosis or procedure occurred. Thus, claims data were a better measure of medication availability than medical records, but the failure to fill a prescription (based on claims data) was not a good indicator of a physician's failure to prescribe a medication. Third, the study used claims data to simulate a letter reminder system that would notify physicians if problems were associated with any of their patient care activities. The assumption is that information from claims data could be used to reach out to families and encourage them to be seen for routine, prevention oriented asthma care.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Benedict, Beth
410-786-7724

PIC ID: 7192

PERFORMER: University of Alabama, School of Public Health
Birmingham, AL

EXPECTED DATE OF COMPLETION: 06/30/2000

Evaluating the Use of Quality Indicators in the Long Term Care Survey Process

The Health Care Financing Administration's (HCFA's) goal is to move towards a regulatory monitoring system that allows for an appropriate use of indicators to evaluate the quality and appropriateness of care provided to residents, and to determine a facility's compliance with the long-term care requirements. This study will develop and test (with volunteering State survey agencies) various options for using a variety of quality indicators to improve the effectiveness and efficiency of the HCFA's facility performance monitoring.

AGENCY SPONSOR: Office of Clinical Standards & Quality

FEDERAL CONTACT: Nonemaker, Sue
410-786-6825

PIC ID: 7177

PERFORMER: Research Triangle Park
Research Triangle Park, NC

EXPECTED DATE OF COMPLETION: 09/29/2003

Evaluation of the Nursing Home Case-Mix and Quality Demonstration

This project will help the HCFA determine the impact of specific ancillary services on the Resource Utilization Groups (RUG). It analyzes and potentially refines the extensive care and other categories to determine the impact on the prospective payment system for skilled nursing homes.

AGENCY SPONSOR: Center for Health Plans & Providers

FEDERAL CONTACT: Peden, Edgar
410-786-6594

PIC ID: 6307

PERFORMER: Abt Associates, Inc.
Cambridge, MA

EXPECTED DATE OF COMPLETION: 09/01/2000

Measurement, Indicators, and Improvement of the Quality of Life in Nursing Homes

This task order will design an evaluation to examine quality of life (QOL) issues for nursing home residents. It will focus on three topics: (1) measuring and developing indicators of QOL, (2) developing quality improvement programs for nursing home QOL, and (3) evaluating environmental design influences on QOL.

AGENCY SPONSOR: Office of Clinical Standards & Quality

FEDERAL CONTACT: Pratt, Mary
410-786-6867

PIC ID: 7176

PERFORMER: University of Minnesota
Minneapolis, MN

EXPECTED DATE OF COMPLETION: 11/30/2000

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.

Fiscal Year 1999 Evaluation Reports

Community Health Centers

Development and Testing of Emergency Department Utilization as a Measure of Effectiveness for the Health Care for the Homeless Program

The purpose of this study was to test the hypothesis that the presence of a Health Care for the Homeless (HCH) program in a community, by providing homeless clients with a medical home, reduces their use of emergency departments (EDs) for non- emergency use. The HCH program provides primary care and substance abuse services for over 450,000 homeless annually. Through outreach, case management, and linkages with social services, the program has provided homeless clients with a comprehensive medical home. This study took a sample of homeless people in six communities with HCH projects. The study assisted in developing performance measures for the HCH program, and provided a foundation for future evaluation studies. For the six study sites, the project provided information on the ability of the HCH program to divert inappropriate use of EDs.

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Wells, Barbara, Ph.D.
301-594-4463

PIC ID: 7415

PERFORMER: Lewin Group
San Francisco, CA

Primary Care of Patients with Hypertension By Community Health Centers

Community health centers (CHCs) are private, not-for-profit or publicly supported organizations that provide primary health care in medically-underserved areas throughout the U.S. and its territories. These health centers play an integral role in the Nation's safety net for people who lack health insurance or face other barriers to health care. As such, they receive substantial Federal support through grant funds and the Medicaid and Medicare programs. In 1994, the Bureau of Primary Health Care funded an in-person survey of CHC users modeled on the National Health Interview Survey (NHIS). The survey found that CHC users are disproportionately at risk for hypertension, and therefore at serious risk for coronary heart disease, stroke and premature death. The purpose of this project is twofold: (1) to compare the prevalence of hypertension among adult CHC users with other low-income, vulnerable U.S. adults who may similarly face barriers to health care; and (2) to assess whether CHC care of hypertensive patients meets nationally accepted standards.

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Regan, Jerrilynn
301-594-4283

PIC ID: 6805

PERFORMER: Mathematica Policy Research, Inc.
Princeton, NJ

Results of a Multisite Study of Mandatory Medicaid Managed Care Enrollment Systems: Implications for Policy and Practice

Under most Medicaid managed care programs, beneficiaries who do not select a plan are automatically assigned to one. This study describes the effects of enrollment and autoenrollment (automatic assignment) policies and practices under mandatory Medicaid managed care on federally qualified health centers (FQHCs), FQHC networks and plans, and their patients. The research indicated that while states had similar enrollment practices, their approach to outreach and education regarding enrolling in managed care differed; the lack of information available to beneficiaries on providers and plan networks was seriously compromising or foreclosing their choices; the rate of autoenrollment was not necessarily a useful means of assessing the effects of Medicaid policies; managed care plans were more concerned about the overall decline in Medicaid cases and financial losses due to the instability of the pool of eligible beneficiaries than in autoenrollment policies; while enrollment was important to FQHCs, they were more concerned about financing and reimbursement; beneficiaries felt the ability to choose and stay with a particular provider was their most important concern, despite the emphasis on choosing a plan during enrollment; and although information provided to beneficiaries was limited, they valued material from such familiar sources as their regular provider. Most important of all, the research revealed that pressure from the rapid implementation of enrollment and autoenrollment policies was creating a lack of accurate information on provider networks both before and during enrollment. The report recommends States make advance preparations for mandatory enrollment periods to ensure that more comprehensive information is available to beneficiaries.

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Jones, Dana
301-594-4058

PIC ID: 6803

PERFORMER: George Washington University, Center for Health Policy Research
Washington, DC

Cross-Cutting

A Pilot Study to Identify Infrastructure Building Across HRSA Programs

The Health Resources and Services Administration (HRSA) provides a healthcare infrastructure or safety net for certain vulnerable and underserved populations through such programs as Ryan White Pediatric AIDS and Healthy Start, a program to reduce deaths among babies in areas with high rates of infant mortality. This study examined various communities to describe how HRSA programs contribute to its goals and how its funding affects the development of a community's healthcare safety net. The research indicated that while HRSA funds only a small portion of the total support of an organization, regardless of the amount, the money is being used to leverage additional funding. Without HRSA funding, some essential services would be significantly reduced or cease to exist altogether. These and other findings as well as recommendations for collecting information for future assessment and planning purposes were included in the study.

AGENCY SPONSOR: Office of the Administrator

FEDERAL CONTACT: Townsend, Jessica
301-443-0371

PIC ID: 6814

PERFORMER: Mathematica Policy Research, Inc.
Washington, DC

Demonstration and Evaluation of Diverse Methods of Technical Assistance Provision to HBCUs

The purpose of this study was to determine the better of two approaches for providing technical assistance to Historically Black Colleges and Universities (HBCUs) to increase their participation in Health Resources and Services Administration (HRSA) projects. Because HBCUs have had a long tradition of providing social services to minority and low-income communities, they are particularly well-suited for participating in HRSA's programs aimed toward ensuring access to adequate healthcare for minorities and disadvantaged groups. The two approaches evaluated for delivering technical assistance were to conduct workshops: (1) in a regional setting, involving 20 HBCUs, and (2) on-site at campuses of 5 HBCUs. The study determined that the former was the better of these approaches. This and other findings and recommendations were included in the study.

AGENCY SPONSOR: Office of the Administrator

FEDERAL CONTACT: Dandy, Roscoe
301-443-6582

PIC ID: 6812

PERFORMER: Institute for College Research Development and Support
Silver Spring MD

Recommended Design and Strategy for NY GME Demonstration and National BBA GME Provisions (Tasks 5 and 6--Basic Contract)

The purpose of this study, which is jointly sponsored by the Health Resources and Services Administration (HRSA) and the Health Care Financing Administration (HCFA) and managed by HCFA, is to develop: (1) a design for evaluating a demonstration financed by the HCFA in 1997 in selected New York State teaching hospitals, and (2) recommendations for evaluating Phase II of the demonstration, along with related provisions of the Balanced Budget Act (BBA). The 42 hospitals in the current demonstration volunteered to reduce the number of resident physicians in training by 20 percent or more over a five year period, while maintaining or increasing the proportion in their primary care program. In return, the HCFA provides transition payments of $400 million over six years. The hospitals repay the payments if they fail to meet their reduction targets. The BBA provides similar options for hospitals in other States and modifies the transitional payment policies by eliminating payment for the first five percent reduction in the full-time equivalent residents. Evaluation objectives include: (1) performance in meeting targets for reductions, (2) impact on access and efficiency, and (3) potential spillover effects on non-participating hospitals.

AGENCY SPONSOR: Office of the Administrator

FEDERAL CONTACT: Townsend, Jessica
301-443-0371

PIC ID: 7132

PERFORMER: Health Economics Research, Inc.
Waltham, MA

HIV/AIDS Services

Development of Estimates of Unduplicated Annual Administrative Report Client Counts Based Upon Client-Level Demonstration Projects

This report provides estimates for the degree of duplication in the Annual Administrative Report (AAR) database in the number of clients receiving Title I and Title II Ryan White Comprehensive AIDS Resources Emergency Care Act (CARE) services. The goal of the research was to develop and test statistical models for predicting unduplicated counts of clients receiving the services using the information contained in the Annual Administrative Report (AAR) and to determine the degree that the aggregate AAR data overestimates the number of clients served with Ryan White funds. These estimates were needed for evaluation and information purposes, including the Government Performance and Results Act (GPRA). Estimates were needed for the number of clients by state and for the nation. The overestimate was calculated at 37 percent, thus reducing the total of AAR clients reported in 1996 to 502,064. Thus, the Ryan White program managed to serve a little over half (55.5 percent) of the 950,000 people who had HIV in the United States in 1996. The regression analysis model developed in the study was a significant improvement over other methods.

AGENCY SPONSOR: HIV/AIDS Bureau

FEDERAL CONTACT: Milberg, John
301-443-8729

PIC ID: 6808

PERFORMER: Harvard Pilgrim Health Care
Boston, MA

Maternal and Child Health

Infant Mortality Prevention in American Indian Communities: Northern Plains Healthy Start

This report is part of a national cross-site evaluation of the 15 funded demonstration projects funded by HRSA on the Healthy Start program regarding infant mortality. Because the Northern Plains project exhibits features unique to rural Indian communities, such as a higher incidence of post-neonatal mortality, and because it is so large and complex, the evaluation team conducted a special study of Northern Plains Healthy Start (NPHS). As with the broader national study, the NPHS evaluation draws on multiple data sources, analyzing data from site visits, focus groups, the project's client data system, a post-partum survey, and vital statistics. The data from the report do not demonstrate a significant impact on infant mortality from the NPHS program. However, there were significant project effects on the adequacy of prenatal care and the incidence of adolescent pregnancy.

AGENCY SPONSOR: Office of the Administrator

FEDERAL CONTACT: Thiel Raykovich, Karen
301-443-0370

PIC ID: 5610.2

PERFORMER: Mathematica Policy Research, Inc.
Washington, DC

State Children's Health Insurance Program

An Analysis of Implementation Issues Relating to CHIP Cost-Sharing Provisions for Certain Targeted Low Income Children

Title XXI of the Social Security Act permits State Children's Health Insurance Programs (CHIP) to impose cost sharing on beneficiaries, when the program is not an expansion of the State's Medicaid program. (Under Medicaid, cost-sharing for services to children is prohibited.) This project analyzes cost-sharing models that can be used by States to track cumulative out-of-pocket expenditures for State CHIP activities and employer-based health insurance plans that participate in CHIP; and reviews findings from studies that examine the relationships among health insurance premiums, cost-sharing arrangements, and enrollment and utilization by low income families. Findings will inform guidance for States in designing cost-sharing provisions for the CHIP plans.

AGENCY SPONSOR: Office of the Administrator

FEDERAL CONTACT: Brand, Marcia K.
301-443-4619

PIC ID: 7129

PERFORMER: George Washington University
Washington, DC

In-Process Evaluations

Community Health Centers

Assessment of Domestic Violence Interventions and Staff Training Protocols in Community-Based Primary Care Health Care Settings

The purposes of this study are to examine a) the characteristics/components of the domestic violence protocols used in HRSA-funded community-based primary health care centers; b) the effect that these protocols have on the reporting of violence, clinical diagnoses, and referrals to local community services among female clients; and c) how other BPHC-funded programs can develop domestic violence interventions in their organizations and communities. Health providers often treat abused women without recognizing or addressing the underlying causes of their health condition. A 1995 survey of 10 BPHC-funded primary health care sites found that only half had a formal tool for assessing domestic violence. This study will analyze time series data to compare the effects of incorporating a protocol on domestic violence. Statistical analysis will control for sociodemographic characteristics and other known confounders. In-depth telephone interviews will be conducted with health care center staff (protocol developers, trainers, and key program coordinators). Documentation, screening, and reporting procedures will be reviewed. Training and referral strategies will be analyzed. Nine sites will be selected for study based on a comprehensive literature review of domestic violence interventions during the past five years. A Steering Committee for Family and Intimate Partner Prevention Violence, comprised of HRSA staff, will provide advice on methods.

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Shannon, Kathleen
301-594-3621

PIC ID: 7284

PERFORMER: North American Management Company
Alexandria, VA

EXPECTED DATE OF COMPLETION: 09/19/2000

Determinants of Change in Health Center Revenues, Service Capacity, and Payor Mix at the Marketplace Level

The purpose of this study is to examine the impact of changes in environmental and management factors in the health care system on the revenues, service capacity, and payor mix of Community Health Centers (CHCs). A previous study found that nationally, Medicaid users have decreased, uninsured users have increased, and Medicaid revenues per user have decreased somewhat. This study will explore CHC-specific data in selected areas of the country. Independent variables to be studied include the percentage of Medicaid recipients in managed care and the overall managed care penetration; the percentage and growth of uninsured; the number and nature of HMOs providing Medicaid services; the safety net provider capacity; Medicaid enrollment; patient access/satisfaction; participation in integrated delivery systems and networks; extent of CHC participation in managed care and; CHC performance (based on nine measures used in BPHC's health center reinvestment process). Data will be drawn from the 12 areas in the RWJ Community tracking study, complemented by BPHC Market Place Analysis information for 4-5 areas. Relevant State Insurance Department and State Hospital Association data, and the Dartmouth Atlas will be reviewed. Data for CHCs will be drawn from BPHC's Uniform Data System.

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Regan, Jerrilynn
301-594-4283

PIC ID: 6784

PERFORMER: Zuvekas, Ann, Consultant
Annandale, VA

EXPECTED DATE OF COMPLETION: 09/30/2000

Evaluation of the Effectiveness and Impact of Community and Migrant Health Centers: Implementation Phase

This comprehensive evaluation of the effectiveness and impact of Community Health Centers (CHCs), begun in 1994, has two components. The content of care component will assess CHC clinical performance and suggest indicators of targets of opportunity for improving patient health status. The Medicaid analysis portion of the study is using Medicaid claims data from seven States (one with Medicaid managed care) to examine three questions: (1) Is there a difference in case mix between Medicaid beneficiaries using CHCs and beneficiaries using other providers of primary care? (2) Are there differences in utilization and expenditures between CHC users and non-users, and what is the effect of adjusting for case mix on these differences? (3) How do CHC characteristics contribute to differences in use and expenditures among CHC users? The findings from this study will identify opportunities and challenges for health centers in both fee-for-service and managed care settings. (See PIC ID 4918)

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Darling, Elizabeth
301-594-4308

PIC ID: 4918.1

PERFORMER: MDS Associates, Inc.
Wheaton, MD

EXPECTED DATE OF COMPLETION: 11/30/1999

Evaluation of the Relationship Between Enabling Services and Patient Access and Outcomes

Community and Migrant Health Centers (C/MHCs) provide extensive enabling services to facilitate access to care for vulnerable populations. These services--which include transportation, translation, case management, health education, nutrition counseling and outreach-- are not typically reimbursed under managed care. The purpose of this study is to analyze the types and levels of enabling services provided by C/MHCs, how these services have changed over time, and whether enabling services improve outcomes and reduce costs. Study findings will be used to inform national program expectations and to guide C/MHCs in structuring their enabling services to maximize access to primary care and preventive services.

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Butler, Fred, Jr.
301-549-4281

PIC ID: 7126

PERFORMER: MDS Associates, Inc.
Wheaton, MD

EXPECTED DATE OF COMPLETION: 10/29/1999

Health Care Status Outcome Measures for the Bureau of Primary Health Care: The Assessment of Ambulatory Care Sensitive Conditions Through State Medicaid Research Files

This project will compare the relative risk of inpatient hospitalizations for Community Health Center (CHC) users with non- CHC users for ambulatory care sensitive conditions. Ambulatory care sensitive conditions are those considered preventable, treatable, or controllable in an outpatient setting. The project will design and test a methodology using selected areas in selected states from the newly available State Medicaid Research Files (SMRF). Major research questions for the study include: (1) the best methodological design to assess relative risk of inpatient hospitalizations for selected ambulatory conditions; (2) the relative risk of inpatient hospitalizations.

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Wells, Barbara, Ph.D.
301-594-4463

PIC ID: 6364

PERFORMER: MDS Associates, Inc.
Wheaton, MD

EXPECTED DATE OF COMPLETION: 06/30/1999

Health Status Outcome Measures for the Bureau of Primary Health Care: Examination of Episodes of Care for Diabetes, Hypertension, Asthma and Other Ambulatory Care Sensitive Conditions

A consensus conference in December, 1995 recommended the use of Medicaid data to examine changes in utilization patterns for Community Health Center (CHC) patients diagnosed with ambulatory care sensitive conditions (ACSCs). These are conditions which frequently can be managed with timely and effective treatment in outpatient settings, thus preventing the need for hospitalization. The purpose of this study is to compare episodes of ambulatory care for CHC users to those of non- CHC users when both have been hospitalized with a primary diagnosis of diabetes, hypertension, asthma, or other ACSCs, as well as when neither has been hospitalized. A previous study (See PIC ID 6001) showed that Medicaid beneficiaries who received most of their care from CHCs had lower hospitalization rates for ACSCs than did non-CHC users. Findings of the current study will improve understanding as to why CHC users experience lower hospitalization rates for ACSCs, and may have different patterns of ambulatory care use. Findings should also identify the major strengths and limitations of the State Medicaid Research Files for examining episodes of care for a comparison of CHC users and non-CHC users.

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Wells, Barbara, Ph.D.
301-594-4463

PIC ID: 7127

PERFORMER: MDS Associates, Inc.
Wheaton, MD

EXPECTED DATE OF COMPLETION: 06/30/2000

Health Status Outcomes for the Bureau of Primary Health Care: A Pilot Study Assessing Physiologic Measures Through Medical Record Review

Through a review of medical records, this study will assess changes in health status among a sample of adult patients of Community Health Centers (CHCs). The conditions selected for evaluation are hypertension and diabetes mellitus. The review will address: (1) the definition of a CHC "user"; (2) confirmation of a diagnosis; (3) patient stratification by severity and/or onset of the condition; (4) expected attrition rates; (5) inclusion of insurance/payer status as a control variable; (6) the time frame in which the two conditions will be measured; (7) protocol for sampling medical records; (8) development of an index of co-morbidities; (9) preparation of a taxonomy of CHC site characteristics; and (10) the appropriate instrument for extracting pertinent data. This project continues the HRSA's systematic effort to identify health status outcomes that may be used to measure the effectiveness of primary care programs.

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Wells, Barbara, Ph.D.
301-594-4463

PIC ID: 6802

PERFORMER: The Lewin Group
Fairfax, VA

EXPECTED DATE OF COMPLETION: 10/31/1999

Impact of Publicly Funded Insurance Programs on Pediatric Safety -Net Providers

The purposes of this study are to a) describe the relationship between characteristics of publicly- funded programs and the survival/financial viability of pediatric safety-net providers; b) determine the differential effects of Medicaid Managed Care (MMC) and the implementation of the State Children's Health Insurance Program (S-CHIP) for pediatric safety-net hospitals relative to pediatric Federally Qualified Health Centers (FQHCs); c) investigate institutional and organizational factors among pediatric safety-net providers; and d) examine the success and failures that these providers have experienced in confronting changes in their community. Improved understanding of the impact of major policy changes on the viability of community pediatric safety-net health care providers can facilitate program strategies to lessen adverse consequences for vulnerable children. Case studies and interviews will be conducted to examine changes in the financial status of these institutions. A logistic regression model will be used to estimate the impact of hospital, market, and policy factors on closure of safety-net providers. Hospital cost, revenue, and profit equations will be estimated using a fixed effects regression model.

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Collins, Felicia L.
301-594-3732

PIC ID: 6039

PERFORMER: Northwestern University, Institute for Health Services Research and Policy Studies
Evanston IL

EXPECTED DATE OF COMPLETION: 09/30/2002

Year 2000 Community Health Center and National Health Service Corps User/Visit Survey

The purpose of this study is to conduct: 1) a personal interview survey of users of Community Health Center/Maternal and Child Bureau sites; 2) a separate record-based study of visits to these sites; and 3) a pilot test of the feasibility of a prospective sampling strategy for use in the Community Health Center and National Health Service Corps User/Visit Survey. The user and visit survey will provide in-depth information about the socio-demographic characteristics of users, their risk behaviors and health status, the reasons they seek care, most frequent diagnoses, satisfaction with care, monitoring of chronic conditions, and the services used in a medical encounter. Attention will be paid to whether the sites provide care that meet or exceeds the Healthy People 2000 and 2010 national objectives. A sample of 50-60 grantee health centers and 15 non-grantee, freestanding sites will be selected, and a sample of 40-50 clients per center/site from medical records. Sampling from the 48 contiguous States will involve urban /rural and the West, Midwest, Northeast, and South Census regions. Questions will be taken from the National Health Interview Survey to allow comparisons with the national population. A retrospective sample of visits will be drawn to obtain a profile of the kinds of conditions treated and services provided.

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Regan, Jerrilynn
301-594-4283

PIC ID: 6811

PERFORMER: Research Triangle Park
Research Park, NC

EXPECTED DATE OF COMPLETION: 04/30/2001

Cross-Cutting

Analysis of Client-Level Data from the National Survey of Homeless Assistance Providers and Clients

The purpose of this study is to analyze the characteristics and health service use patterns of homeless people with special needs, and how the homeless population with alcohol, drug, and mental health problems compares to the general population. Issues to be addressed include: a) comparison of the rates of alcohol, drug, and mental health problems, and related treatment patterns with the general or low-income population; b) development of severity indexes on domains such as health, mental health, substance abuse, employability, and receipt of benefits; c) variation of service utilization patterns and their association with other significant variables (e.g., effect of Medicaid or other type of insurance on type and frequency of treatment); d) the relationship between severity indexes, service use patterns, and the history or nature of homelessness (e.g., relationship between treatment history and homelessness); and e) the factors associated with reported service needs and problems (e.g., reports of difficulty accessing primary/dental care). Core data (available in August 1999) will be drawn from the National Survey of Homeless Assistance Providers and Clients (NSHAPC), the first national-level and comprehensive survey of homeless clients since 1987. The NSHAPC has data on providers in 76 U.S. geographic regions, 52 urban and 24 small/rural cities, and a nationally representative sample of clients served by these providers. It was conducted by the Census Bureau on behalf of 12 Federal sponsoring agencies.

AGENCY SPONSOR: Office of the Administrator

FEDERAL CONTACT: Araki, Lynette
301-443-6204

PIC ID: 7250

PERFORMER: Westat, Inc.
Rockville, MD

EXPECTED DATE OF COMPLETION: 09/30/2000

Development of an Inventory of Health Indicators Comparing Large U.S. Cities

The purpose of this study is to develop a fourth edition of Big Cities Inventory, an inventory comparing mortality, natality, and morbidity data for the nation's large cities. Local health departments require comparative data to determine the relative progress in their population's health. Although county data are available, large city health departments often cannot distinguish their own performance from surrounding counties that may have very different socio-demographic and resource characteristics. Data needs will be identified in consultation with members of the National Association of County and City Health Officials (NACCHO), who are from big cities, and the previous three editions of the Big Cities Inventory (Chicago Department of Public Health). Issues and barriers encountered in collecting and analyzing comparable data from national and local data sources will be documented. A plan for automating future editions of the Big Cities Inventory will be prepared, including approaches for using Web-based technology to disseminate the report.

AGENCY SPONSOR: Office of the Administrator

FEDERAL CONTACT: Millman, Michael
301-443-0368

PIC ID: 7241

PERFORMER: Chicago Center for Health Systems Development
Chicago, IL

EXPECTED DATE OF COMPLETION: 09/30/2000

Health Needs of Gay, Lesbian, Bisexual, and Transgender Communities

The purpose of this study is to develop a white paper that articulates and defines barriers to access to quality preventive and primary care health services for Gay, Lesbian, Bisexual, and Transgender (GLBT) populations. The information paper will provide a comprehensive review of the existing literature on health care and sexual orientation and will consist of two parts. The first part will be a rationale for studying health and sexual orientation by focusing on the epidemiological evidence of differential disease occurrence in GLBT populations, the hypothesized risk and protective factors related to these differences, and possible differences in response and access to therapies. The second part will explore methods to study the health of GLBT populations, including reviewing existing data sources, obtaining probability samples, measuring the dimensions of sexual orientation appropriate to particular health questions, and asking questions in sensitive and answerable ways.

AGENCY SPONSOR: Office of the Administrator

FEDERAL CONTACT: Clarke, Melissa
301-443-5277

PIC ID: 6813

PERFORMER: Gay and Lesbian Medical Association
San Francisco, CA

EXPECTED DATE OF COMPLETION: 09/30/2000

Historically Black Medical Colleges' Participation in HRSA-Supported Health Professions Training Programs

The purpose of this study is to conduct a comprehensive assessment of the level of participation of Historically Black Medical Colleges (HBMCs) in HRSA-supported health professions training programs. These institutions are Meharry Medical College, Morehouse School of Medicine, Howard University, and Charles R. Drew University of Medicine and Science. Since 1995, HBMCs have received HRSA funding in several areas, mainly through health professions programs. However, HBMC funding declined during FY 1995-FY 1997, although appropriations for health professions training did not decline. HBMC Annual Performance Reports and documents relating to the HRSA peer review process will be reviewed. Interviews will be conducted with HRSA officials to gain perspective on grant processes and the role of HBMCs in HRSA programs, and to determine the type of technical assistance provided to applicants under the 16 programs for which HBMCs are eligible. HBMC staff also will be interviewed. The findings of this study will assist in determining whether changes in policies or processes are needed to increase the participation of HBMCs in HRSA-supported health professions training programs.

AGENCY SPONSOR: Office of the Administrator

FEDERAL CONTACT: Clark, Gwendolyn B.
301-443-5619

PIC ID: 7121

PERFORMER: Health Resources and Services Administration
Rockville MD

EXPECTED DATE OF COMPLETION: 09/30/2000

State-Level Assessment of Current Access and Utilization of Dental Services and Dental Services Infrastructure

The purpose of this study is to establish and assess baseline data concerning the public health infrastructure and dental services utilization in the West Central Region VIII. In many States, there is limited capacity to collect and analyze data to evaluate oral health programs with respect to access to dental services for the underserved and disparities in oral health. This project will involve three States (North Dakota, South Dakota, and Colorado) in the collection of oral health data and Geographic Information System (GIS) Mapping. Analysis will focus on the location of HRSA-funded and non-HRSA oral health programs; a related dental workforce of dentists and dental hygienists by county; the current use of dental services by age and county; the types of dental services provided by State, regional, and local-based public systems of care; the proportion of Medicaid, private, or other dental insurance coverage by county; and State demographic characteristics. Products will include a directory of existing HRSA-funded dental programs, mapping of utilization by area, and baseline data used to evaluate progress in HRSA's Oral Health Initiative.

AGENCY SPONSOR: Office of the Administrator

FEDERAL CONTACT: Sutherland, James N.
303-844-3204

PIC ID: 7242

PERFORMER: Quality Resource Systems, Inc.
Fairfax, VA

EXPECTED DATE OF COMPLETION: 09/30/2000

Expanding Access to Care

Safety-Net Provider Capacity for Care to Low-Income Uninsured Patients

The purpose of this study is to evaluate the capacity of health departments, public hospitals, and other community-based, safety-net providers to serve the low-income uninsured. Evidence indicates that these safety-net providers are under increased financial pressure due to Medicaid managed care, reduced State funds for the direct delivery of health care services, and a continued rise in the number of uninsured and under-insured. The capacity of safety-net providers is to be measured in terms of change in revenues to serve the low-income uninsured (e.g., change in operating margins or limits on cash reserves), number and type of patient encounters, and the proportion of services provided. Secondary data analysis and site visits will be conducted in twenty communities, with both urban and rural locations. Secondary data will be drawn from AHA's and National Association of Public Hospitals' surveys, NACCHO's survey of local health departments, HRSA's data on community and migrant health centers, CDC's proposed tracking of health departments, and RWJ's Community Tracking Study of community-based providers. Time series analysis will include three years of the most recent available data. Site visits will collect information on State and local government policies that influence the safety net and the role of local provider organizations in the viability of the safety net. Focus groups and interviews with providers and local public health officials will be held in each of the sampled communities. With emphasis on HRSA-supported programs, this study will help policy makers to identify the impact of shifts in health care financing on services provided to low-income uninsured patients. Resources within HRSA's service delivery program can be reallocated to ensure that those most needing care are served.

AGENCY SPONSOR: Office of the Administrator

FEDERAL CONTACT: Ross, Alexander
301-443-1512

PIC ID: 7240

PERFORMER: Mathematica Policy Research, Inc.
Washington, DC

EXPECTED DATE OF COMPLETION: 09/30/2000

Health Professions

Employment Sites of Nursing Graduates Supported by the Professional Nurse Traineeship Program

Professional Nurse Traineeship (PNT) grants are awarded to eligible institutions for the support of students in advanced nursing education. Traineeships are then awarded by the institutions to individuals enrolled in masters and doctoral programs to prepare for practice as advanced practice nurses. These funds are distributed to institutions based on a formula that incorporates three statutory funding factors. The factor to be studied is the statutory general funding preference which is given to institutions that demonstrate either: (1) a high rate of placing graduates in medically underserved communities (MUCs), or (2) a significant increase in the rate of placing graduates in such settings. Comparisons of employment sites of graduates in school receiving the preference with those of graduates in schools not receiving the preference will indicate the significance of a funding preference in promoting program objectives of increasing access to care in underserved communities. The data collected through this survey will help to formulate programmatic and policy recommendations designed to strengthen and increase the effectiveness of the PNT program.

AGENCY SPONSOR: Bureau of Health Professions

FEDERAL CONTACT: Johnson, Ayah, Ph.D.
301-443-6315

PIC ID: 7130

PERFORMER: Mathematica Policy Research, Inc.
Washington, DC

EXPECTED DATE OF COMPLETION: 04/28/2000

Nurse Staffing and Quality of Care in Hospitals

The purpose of this study is to identify patient outcome measures that are sensitive to variations in nurse staffing in acute care hospital settings. Changes in the health care system have raised questions about the quality of patient care. Recent reviews by the Institute of Medicine recommended research on the relationship between quality of inpatient care and level and mix of nurse staffing. Also, the Health Care Financing Administration has drafted proposed Conditions of Participation for Hospitals that must be met if hospitals are to participate in Medicare/Medicaid programs. This study will address these concerns in Phase I by identifying and assessing current studies/methods that are focused on patient outcomes that are sensitive to nurse staffing. Existing and pending data bases useful for conducting research on the sensitivity of patient outcomes to variations in nurse staffing will be identified as will alternative study designs that can provide nationally generalizable information. Phase II will involve acquiring data bases and conducting both descriptive and multivariate analysis of the relationship between nurse staffing and patient outcomes.

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Moses, Evelyn
301-443-6315

PIC ID: 6864

PERFORMER: Harvard University, Holyoke Center
Cambridge MA

EXPECTED DATE OF COMPLETION: 08/31/2000

HIV/AIDS Services

Comparison of Services Received and Health Outcomes for Persons Funded by the CARE Act and by Other Sources

The purpose of this study is to compare demographic characteristics, services needed and provided, and health outcomes between persons receiving CARE Act-funded services and the general treatment population. Increasing demands for accountability, shifts in the populations affected by the HIV epidemic, and the development of effective combination therapies have been associated with increases in the number of people living with HIV who will need care for longer periods of time. While a great deal is known about the types of services and providers supported under the CARE Act, the demographic characteristics of, and services used by, patients are less clear because of a lack of client-level reporting mechanisms. The findings of this study will help to develop an empirical basis for program accountability and performance measurement.

AGENCY SPONSOR: HIV/AIDS Bureau

FEDERAL CONTACT: Conviser, Richard
301-443-3075

PIC ID: 7123

PERFORMER: Johns Hopkins Medical Institutions
Baltimore, MD

EXPECTED DATE OF COMPLETION: 10/31/1999

HIV Service Utilization and Health Outcomes for PLWH with Comorbidities in RWCA-Funded Programs

The purpose of this study is to evaluate (a) the additional demands placed on the health care system by individuals living with HIV infection who have comorbid conditions and (b) the benefits and costs of integrating and coordinating treatment for these conditions. Two separate projects are underway. The Johns Hopkins University will describe and quantify the delivery of comorbidity services, compare this delivery with established guidelines and standards, and analyze the outcomes of the HIV infection and selected comorbidities (substance abuse, psychiatric illness, and hepatitis C). The Washington University School of Medicine will study comorbidities of adult and adolescent women with HIV. Conditions include chemical dependency, mental illness, TB, STD, cervical dysplasia and cancer, diabetes, hypertension, renal failure, and hepatitis B and C. Homelessness and encounters with the criminal justice system will also be explored. The project will analyze how many clients are receiving services for comorbid conditions and HIV, the standard of medical care for those with these conditions, and changes in this standard during 1996-1998. At least one publishable article is to discuss how grantees and planning bodies can use study findings to optimize the delivery of services under the Ryan White CARE Act.

AGENCY SPONSOR: HIV/AIDS Bureau

FEDERAL CONTACT: Pounds, Moses B., P.hD.
301-443-2894

PIC ID: 7267

PERFORMER: Johns Hopkins University School of Medicine
Baltimore, MD and Washington University School of Medicine, St. Louis, MO

EXPECTED DATE OF COMPLETION: 09/30/2000

HIV/AIDS Cost Analysis and Development of Capitation Rate Methodology

The purposes of this study are to a) determine how utilization of services for people living with HIV (PLWH) is associated with comorbidities (especially substance abuse and mental illness); b) develop a method(s) for determining capitation rates for HIV/AIDS populations under Medicaid managed care systems (MCOs) that take comorbidities into account; and c) evaluate the impact of protease inhibitor combination therapy on care costs. Most capitation rates paid for people with HIV-- that has not yet developed into AIDS-- are substantially lower than the cost of care. High enrollments of PLWH place MCOs at financial risk. Preliminary studies in Maryland suggest that there is nearly as much variability in the costs of HIV care as there is in the costs of AIDS care; a key factor may be comorbidities that have a major impact on the cost of HIV care. This study will analyze Maryland State Medicaid data from FY 1997 to determine the extent to which comorbidities are associated with variations in demand for services. Evaluation will be made of rate setting methodologies that take into account comorbidities in determining per member, per month costs of treatment. Maryland's Medicaid reimbursement for protease inhibitors above capitation rates also will be assessed. The study will illuminate the possible need to factor comorbidities into capitation rate-setting methods and the adoption of special HIV as well as AIDS capitation rates for MCOs.

AGENCY SPONSOR: HIV/AIDS Bureau

FEDERAL CONTACT: Conviser, Richard
301-443-3075

PIC ID: 7095

PERFORMER: Univ. of Maryland, Ctr. for Health Prog. Dev. Management
Baltimore, MD

EXPECTED DATE OF COMPLETION: 01/31/2000

Impact of RWCA Title I Funding on HIV Services Utilization and Health Outcomes in Las Vegas, Nevada and Norfolk, Virginia

The purpose of this collaborative project with CDC is to examine the impact of Ryan White CARE Act Title I funding on HIV service use and outcomes in newly eligible metropolitan areas (EMAs). Title I grants are expected to increase each EMA's financial base for planning, developing, and expanding HIV-related health and support services. This project will determine how these funds affect the availability, accessibility, quality, continuity, and integration of care, and HIV-related morbidity (e.g., the incidence of opportunistic infection) and mortality among underserved and vulnerable populations with HIV/AIDS. A cross-sectional pre- and post-analysis of the effects of Title I funding will be conducted in two new EMAs-- Las Vegas, Nevada and Norfolk- Newport News, Virginia. The analysis will provide additional information about the nature and magnitude of the impact of Ryan White program funding on health care services and outcomes for persons with HIV/AIDS.

AGENCY SPONSOR: HIV/AIDS Bureau

FEDERAL CONTACT: Malitz, Faye
301-443-3259

PIC ID: 7215

PERFORMER: HIV/AIDS Bureau
Rockville MD

EXPECTED DATE OF COMPLETION: 09/30/2002

Population- and Data-Based Assessment of Unmet HIV Service Needs

The purpose of this 2-year study is to provide methods for Ryan White CARE Act planning bodies to assess unmet needs for HIV health and support services. Products are to include a qualitative and quantitative assessment of unmet needs for a particular catchment area covered by one or more CARE Act-supported programs in 1999. A complete description of a generalizable and suitable methodology for CARE Act programs to conduct these assessments is also to be provided. The catchment area analysis is expected to include an estimation of overall service needs and the degree to which existing private and public health insurance streams provide health and social services that meet these needs. Estimates are to be compared with catchment area service capacity and client perceptions of unmet need and barriers to care, which can include financial constraints, logistical problems, insufficient availability of services, and lack of provider experience.

AGENCY SPONSOR: HIV/AIDS Bureau

FEDERAL CONTACT: Conviser, Richard
301-443-3075

PIC ID: 7105

PERFORMER: Partnership for Community Health
New York, NY

EXPECTED DATE OF COMPLETION: 09/30/2000

Managed Care

Managed Care and the Safety Net Providers

This study will examine the impact of Medicaid managed care and other changes in health care coverage on the future integrity and viability of safety net providers operating in primary care settings, including those funded by the Health Resources and Services Administration (HRSA), including Community and Migrant Health Centers, Maternal and Child Health programs, Ryan White Comprehensive AIDS Resources Emergency (CARE) Act programs. Findings and recommendations will be disseminated nationally through a variety of mechanisms, including publication of the report and a series of public forums and workshops.

AGENCY SPONSOR: Office of the Administrator

FEDERAL CONTACT: Ross, Alexander
301-443-1512

PIC ID: 6815

PERFORMER: National Academy of Sciences, Institute of Medicine
Washington, DC

EXPECTED DATE OF COMPLETION: 12/31/1999

Maternal and Child Health

National Evaluation of the Healthy Start Program

The Healthy Start program was launched in 1991 by the Health Resources and Services Administration (HRSA) of the U.S. Public Health Service to demonstrate innovative ways to reduce infant mortality in areas with some of the highest rates. The National Evaluation consists of a cross-site process study and an outcome study of the 15 original sites. The final report of the process evaluation, "The Implementation of Healthy Start: Lessons for the Future," was completed in FY 1998 (See PIC ID 5610.1). The outcome evaluation is assessing infant mortality and birth outcomes, including improvements in the adequacy of prenatal care, and the incidence of low and very low birth weight and pre-term deliveries compared to matched comparison communities. The final report will also include findings from a Survey of Postpartum Women, and from special reports on Fetal and Infant Mortality Reviews, Health Education, and Case Management. Study results will be used to improve the Healthy Start projects funded subsequently, and will be shared with the public health community for application in other settings.

AGENCY SPONSOR: Office of the Administrator

FEDERAL CONTACT: Thiel Raykovich, Karen
301-443-0370

PIC ID: 5610

PERFORMER: Mathematica Policy Research, Inc.
Washington, DC

EXPECTED DATE OF COMPLETION: 03/30/2000

The Impact of the State Children's Health Insurance Program on Selected Community Health Centers and Maternal and Child Health Programs

This study is assessing: (1) the effect of the State Children's Health Insurance Program (CHIP) on the insurance status of children served by selected Community Health Centers (CHCs) and Maternal and Child Health (MCH) programs, and (2) the impact on the extent to which these children enter or remain in care at selected CHC and MCH sites. Issues to be addressed include: (1) the insurance history of children who have used or are new to the site; (2) the continuous nature and time span of the coverage; (3) insurance characteristics of, and source care for, children who are no longer users; and (4) the characteristics of sites relative to their ability to enroll and/or retain newly insured children. Previous analysis of CHC encounter files documented significant volatility in coverage, with patients going on and off coverage as many as five times in a given year. Study findings will provide a framework for future investigation, develop a transferable methodology for use by States and sites, and help to assess the extent to which CHIP has affected the insurance coverage of children served by CHCs and MCH programs.

AGENCY SPONSOR: Maternal and Child Health Bureau

FEDERAL CONTACT: Yoon, Jean
301-594-3730

PIC ID: 7125

PERFORMER: George Washington University
Washington, DC

EXPECTED DATE OF COMPLETION: 09/20/2000

National Health Service Corps

Effectiveness of the National Health Service Corps

The purpose of this project is to study the effectiveness of the National Health Service Corps (NHSC), including examination of the various mechanisms for training and recruiting providers, placing them in underserved areas, and retaining them in primary care and related professions. Prior studies have tended to define NHSC "effectiveness" narrowly, e.g., using retention at a particular site as a measure. Current and alumni clinicians and administrators of sites staffed with NHSC clinicians are providing information for the study. Study findings will be used in policy development and program management, and in developing the proposal for new authorizing legislation, needed as of October, 2000.

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Niska, Richard, M.D.
301-594-4204

PIC ID: 6357

PERFORMER: Mathematica Policy Research, Inc.
Washington, DC

EXPECTED DATE OF COMPLETION: 4/30 /2000

State Children's Health Insurance Program

Cost Implications of Providing 12 Months' Continuous Coverage for Children Under Public Health Insurance Mechanisms

The purpose of this study is to assess the effect of extending 12 months of continuous eligibility for Medicaid or CHIP on the administrative and service costs of caring for children. The Balanced Budget Act of 1997 authorized each State: 1) to provide twelve months of continuous Medicaid eligibility for children and 2) to increase the Medicaid match for continuous eligibility under CHIP. However, some States may consider this too expensive to implement versus a two to six-month Medicaid eligibility. Site visits will be made to four States and Medicaid administrative data will be analyzed. Monthly enrollment data and annual expenditure information from 1995 State Medicaid Research Files (SMRF) person summary files, supplemented with site visit information, will be used to estimate the costs of an additional month of coverage. Service cost estimates will be drawn from both fee-for-service and managed care sectors. Estimates of administrative savings will be based on interviews with State personnel and any reduction in the number of re-determinations of eligibility conducted by States (presumptive eligibility). Institutionalized children and children enrolled in the Supplemental Security Income program will not be included in the analysis.

AGENCY SPONSOR: Maternal and Child Health Bureau

FEDERAL CONTACT: Tenenbaum, Jacob
301-443-9011

PIC ID: 7236

PERFORMER: Mathematica Policy Research, Inc.
Washington, DC

EXPECTED DATE OF COMPLETION: 12/31/2000

Indian Health Service

MISSION: The mission of the Indian Health Service, in partnership with American Indian and Alaska Native people, is to raise their physical, mental, social, and spiritual health to the highest level.

Evaluation Program

The goal of the Indian Health Service (IHS) is to assure that comprehensive, culturally acceptable, personal and public health services are available and accessible to American Indian and Alaska Native people. The importance of evaluation in supporting this goal has increased significantly in recent years and includes American Indians and Alaska Natives as the primary stakeholders in defining the purpose, design, and execution of evaluations. The stakeholders use the end product of the evaluations, and are typically the population or groups most likely to be affected by the evaluation findings. The IHS has formally adopted the principles of a responsive evaluation practice to address the needs and concerns of American Indians and Alaska Natives.

The evaluation program of the IHS is managed by the Office of Public Health, Staff Office of Planning, Evaluation, and Research (OPH-SOPER), which provides national leadership and consultation for IHS and Area Offices on strategic and tactical planning, program evaluation and assessment, public health and medical services, research agendas, and special public health initiatives for the Agency. The OPH-SOPER serves as the principal advisory office on issues of national health policy and coordinates the following four evaluation functions.

  • Health Program Evaluations - Collect and analyze information useful for assisting IHS officials in determining the need for improving existing programs or creating new programs to address health needs.
  • Policy Analysis - Conduct analyses when a change in the IHS health service delivery system must be considered, when issues emerge in an area where no policy currently exists, or when current policies are perceived as inappropriate or ineffective.
  • Health Services Research - Undertake analyses of the organization, financing, administration, effects, and other aspects of the IHS delivery of health services.
  • Special Studies and Initiatives - Conduct studies and prepare special reports required by Congress in response to pending legislation or policies, often using a roundtable, whenever an issue or a health problem requires immediate action and it is unclear what type of action should be taken.

The evaluation needs of the IHS service components are coordinated by OPH-SOPER using two major types of short-term studies: policy assessments and program evaluation studies. The IHS policy assessments contribute to decision making about budget, legislation, and program modifications and include background information to support the Agency's initiatives. Evaluation studies are focused at the program level, or Area Offices, and focus on specific program needs.

Each year OPH-SOPER selects high-priority health care and management studies for funding through the submission of proposals to headquarters and Area Offices. These proposals are reviewed and rated by a panel of subject-matter experts, evaluation experts, and IHS staff for concurrence with IHS strategic goals, objectives, and priority areas. The proposals are then prioritized and forwarded to the IHS Director, who reviews the projects that are recommended for funding and determines the respective funding levels.

Fiscal Year 1999 Evaluation Reports

Prevention Services

The Impact of Health Programs on Behavior Among Three United South and Eastern Tribes (USET)

This is a joint report of the Centers for Disease Control and Prevention (CDC) and the Indian Health Service. It describes the results of a 1995-1996 Health Assessment Survey carried out among the Tribal members of three Tribes located within the Nashville area: The Mississippi Band of Choctaw Indians, Philadelphia, PA; the Passamaquoddy Pleasant Point Tribe, Perry, Maine; and, the St. Regis Mohawk Tribe, Hogansburg, New York. The goals of the survey were to learn the extent to which members of these three Nashville Area tribes are practicing selected behaviors that pose risks to their health and well-being, and to measure the prevalence of certain health conditions such as tobacco use, alcohol consumption and drug use as they are related to behavior. The survey was a population-based, face-to-face survey of a representative sample of tribal members who were at least 18 years of age and lived on the tribal reservation. The report concludes that the statistics in the report reveal and emphasize that a medical approach alone to illness and disease is not enough. Success, must include a combination of the science of medicine and the human sciences to improve wellness and to alleviate illness.

AGENCY SPONSOR: Office of Public Health

FEDERAL CONTACT: Fowler, Elizabeth A.
301-443-3024

PIC ID: 5945

PERFORMER: Nashville Area Indian Health Service
Nashville TN

In-Progress Evaluations

Cross-Cutting

Contractual Support to Cover the Cost of IHS Strategic Planning Initiative, Stages II and III

This project will develop an evaluation instrument to assist the Indian Health Service (IHS) Director in addressing management improvement, strategic planning, and promotion of tribal self-determination. Current IHS monitoring systems do not reflect the problems and needs of IHS Area and tribal health delivery systems, nor do they adequately measure the progress in various systems. The project will design and develop an evaluation instrument and a monitoring and evaluation system to meet these needs.

AGENCY SPONSOR: Office of Public Health

FEDERAL CONTACT: Fowler, Elizabeth A.
301-443-3024

PIC ID: 5020

PERFORMER: Indian Health Service
Rockville MD

EXPECTED DATE OF COMPLETION: 12/20/1999

Development of a Health Services Research Agenda for American Indian and Alaska Native Populations

The Indian Health Service (IHS) and the Agency for Health Care Policy and Research (AHCPR) are joining together to develop a long-term health services research (HSR) agenda that reflects the research needs of American Indian and Alaska Native (AI/AN) communities. As a first step in developing this agenda, a conference was held in Albuquerque, New Mexico in August 1996. The conference, based on the IHS roundtable model, included twenty-five to thirty representing tribes and urban Indian health projects, ten to fifteen people with subject area expertise and a few health policy specialists. Tribal and urban conference participants, as well as the HSR Conference Planning Committee members, were selected in consultation with the Area representatives of the National Indian Health Board. The HSR agenda emerging from the conference will help focus and coordinate efforts for greater efficiency among organizations that fund HSR for AI/AN populations. This includes tribes, Federal and State agencies, universities, foundations and other organizations.

AGENCY SPONSOR: Office of Public Health

FEDERAL CONTACT: Fowler, Elizabeth A.
301-443-3024

PIC ID: 6153

PERFORMER: Native American Consultants, Inc.
Washington, DC

EXPECTED DATE OF COMPLETION: 09/30/2000

Evaluation of IHS Capacity for Epidemiologic Surveillance

The purpose of this evaluation is to describe the epidemiologic surveillance capacity of the IHS/Tribal/Urban (I/T/U) system and make recommendations as to how the capacity could be improved to better meet the needs of the IHS and its stakeholders. As the IHS is reorganized, fewer resources will be available to conduct epidemiologic surveillance.

AGENCY SPONSOR: Office of Public Health

FEDERAL CONTACT: Fowler, Elizabeth A.
301-443-3024

PIC ID: 6745

PERFORMER: Indian Health Service
Rockville MD

EXPECTED DATE OF COMPLETION: 12/31/1998

Evaluation of IHS' Program Evaluation, Research, and Policy Analysis Agenda

This project will evaluate the Indian Health Service's evaluation and policy analysis agenda. Specifically, it will examine the quality and effectiveness of evaluations, and will consider whether the amount expended on evaluations is reasonable and appropriate for the studies.

AGENCY SPONSOR: Office of Public Health

FEDERAL CONTACT: Fowler, Elizabeth A.
301-443-3024

PIC ID: 5937

PERFORMER: Indian Health Service
Rockville MD

EXPECTED DATE OF COMPLETION: 09/30/2000

Program Assessment of Co-Morbidity of Chemical Dependency Mental Health and Diabetes

The purpose of this study is to determine outcome of simultaneous treatment of co-occurring chemical dependency, mental health issues and diabetes.

AGENCY SPONSOR: Office of Public Health

FEDERAL CONTACT: Fowler, Elizabeth A.
301-443-3024

PIC ID: 7029

PERFORMER: Indian Health Service
Rockville MD

EXPECTED DATE OF COMPLETION: 12/30/2001

Resource Requirements Methodology Update

This project will update the existing Resource Requirements Methodology (RRM) necessary to reflect current and future program demands of the Indian Health Service (IHS). A complete revision and documentation of the RRM will involve an update of staffing criteria and modules, formulation of a needs assessment cost model, and needs assessment model training.

AGENCY SPONSOR: Office of Public Health

FEDERAL CONTACT: Fowler, Elizabeth A.
301-443-3024

PIC ID: 6450

PERFORMER: Information and Management Technologies, Inc.
Silver Spring, MD

EXPECTED DATE OF COMPLETION: 09/29/2001

Geriatric Services

American Indian Family Caregivers and the Provision of Long-Term Care

This project is intended to help develop economically feasible and culturally acceptable long-term care modalities to support Native American families in delivering care to frail elders.

AGENCY SPONSOR: Office of Public Health

FEDERAL CONTACT: Fowler, Elizabeth A.
301-443-3024

PIC ID: 5940

PERFORMER: Indian Health Service, Office of Planning, Evaluation, and Legislation
Rockville MD 20857

EXPECTED DATE OF COMPLETION: 09/30/2000

Concurrent Evaluation of the Elders Clinic, a Multidisciplinary Geriatric Assessment Clinic at the Zuni-Ramah Service Unit

The purpose of this study is to describe the epidemiologic surveillance capacity of the Indian Health Design Team Indian Health Service (IHS) Provider of Health Care/Tribal Provider of Health Care/Urban Indian Program Provider of Health Care (I/T/U) system. It will also make recommendations as to how the clinical capacity could be improved to better meet the needs of the IHS and its stakeholders. This study is of increasing importance as fewer Federal resources will be available to conduct epidemiologic surveillance.

AGENCY SPONSOR: Office of Public Health

FEDERAL CONTACT: Fowler, Elizabeth A.
301-443-3024

PIC ID: 6741

PERFORMER: Indian Health Service
Rockville MD

EXPECTED DATE OF COMPLETION: 09/20/2000

Health Care Delivery

Continuation and Completion of a Study to Analyze Quality Assurance and HP/DP Monitoring, and Analyze Methods Using Patient Care Component

This study will analyze quality assurance (QA) and health promotion and disease prevention (HP/DP) monitoring and analysis methods using the Patient Care Component (PCC) and Resource and Patient Management Systems (RPMS). These systems are currently in use at the Indian Health Service (IHS) facilities in the Billings area. The project goal is to improve the health status of Indians living in the Billings area by using the PCC database to monitor quality assurance activities and HP/DP objectives, while improving the database's accuracy and completeness.

AGENCY SPONSOR: Office of Public Health

FEDERAL CONTACT: Fowler, Elizabeth A.
301-443-3024

PIC ID: 5018

PERFORMER: IHS Billings Area Office
Billings MT

EXPECTED DATE OF COMPLETION: 12/20/1999

Eastern Band of Cherokee Indian Health Care Delivery System Assessment

This study will provide the Eastern Band of Cherokees with relative data on their current health care service delivery system. This data is intended for use in a re-design of the system so that it can be more responsive to all client and tribal member needs.

AGENCY SPONSOR: Office of Public Health

FEDERAL CONTACT: Fowler, Elizabeth A.
301-443-3024

PIC ID: 6408

PERFORMER: Nashville Area Indian Health Service
Nashville TN

EXPECTED DATE OF COMPLETION: 09/01/2001

Evaluating the Effects of Medical Nutrition Therapy on Patient Outcomes Among Native Americans with Newly Diagnosed Type II Diabetes Mellitus

This study will: (1) evaluate the effectiveness of medical nutrition therapy (MNT) on clinical/behavioral outcomes in American Indians/Alaska Natives (AI/AN) with newly diagnosed Type II diabetes, (2) create a uniform methodology for collecting nutrition-oriented outcome data that is consistent among participating tribes, service units and urban programs, (3) analyze the type and amount of MNT provided with regard to patient outcomes, and (4) link this information with current clinical data from the IHS Diabetes Program which identifies Continuous Quality Improvement performance measures.

AGENCY SPONSOR: Office of Public Health

FEDERAL CONTACT: Fowler, Elizabeth A.
301-443-3024

PIC ID: 6746

PERFORMER: Indian Health Service
Rockville MD

EXPECTED DATE OF COMPLETION: 11/30/1999

Impact of a Structured, Comprehensive, Multi-Disciplinary Patient Education Initiative--Year 2

This study will: (1) promote wellness and prevent disease by providing comprehensive, accurate and understandable education to each patient, (2) study the impact of this multidisciplinary, planned patient education program on the health and wellness knowledge base of the patient population, and (3) document positive lifestyle/behavioral changes as a result of the education provided. The study population encompasses all American Indian/Alaska Native (AI/AN) patients eligible for care at the Service Unit (predominantly Cherokees). The Service Unit covers 12 counties in northeastern Oklahoma with 149,939 outpatient visits, accounting for 32,105 patients. This study will be submitted for publication in current medical journals by the Indian Health Service (IHS) provider. Information generated from this study will be disseminated to all tribes in the service area and all IHS facilities.

AGENCY SPONSOR: Office of Public Health

FEDERAL CONTACT: Fowler, Elizabeth A.
301-443-3024

PIC ID: 7140

PERFORMER: Indian Health Service
Rockville MD

EXPECTED DATE OF COMPLETION: 09/30/2000

Quality Care Project

This project will identify existing office management and information systems, or recommend improvements to the existing one. This will enable the Oneida Nation of New York to initiate services at its permanent comprehensive health facility using the most effective: (1) patient scheduling, (2) billing, and (3) medical records systems available. The project will review the Oneida's current information systems and those used by other Native American health centers. It will evaluate ten other systems and recommend a model for integration into the tribal health department's quality assurance and managed care plans.

AGENCY SPONSOR: Office of Public Health

FEDERAL CONTACT: Fowler, Elizabeth A.
301-443-3024

PIC ID: 4994

PERFORMER: Oneida Indian Nation Health Department
Oneida NY

EXPECTED DATE OF COMPLETION: 12/20/1999

Maternal and Child Health

Dental Caries in Preschool Children

This project will determine the existence of a Baby Bottle Tooth Decay (BBTD) pattern among preschool children clusters in families. It will also determine if dental nutrition education to families with one child with BBTD pattern caries will reduce the rate in subsequent children. Project data will be used to determine the utility of providing family-directed dental and nutrition education can reduce BBTD clusters in families.

AGENCY SPONSOR: Office of Public Health

FEDERAL CONTACT: Fowler, Elizabeth A.
301-443-3024

PIC ID: 5531

PERFORMER: Indian Health Service
Rockville MD

EXPECTED DATE OF COMPLETION: 12/20/1999

Evaluating the Impact of Primary Intervention Techniques on the Dental Caries Rate in Children Living in Southwest Alaska Native Villages

This project will attempt to identify the reason why some communities in Bristol Bay have significantly higher/lower caries rates in children than do other children in other Bristol Bay communities. Children ages six to eight have been selected for the project, and the results of the project will be used to identify the factors that create high-risk communities. A community model will be developed for use in allocating specific resources to address the oral health needs of the villages. The primary activities will continue to be directed towards continuing intervention, which includes dental advocate services, tooth brushing, topical flouride and chemotherapy programs, distribution of children's books, and use of the medical model for dental treatment for one to eight year olds and their mothers.

AGENCY SPONSOR: Office of Public Health

FEDERAL CONTACT: Fowler, Elizabeth A.
301-443-3024

PIC ID: 7138

PERFORMER: Indian Health Service
Rockville MD

EXPECTED DATE OF COMPLETION: 09/30/2000

Impact of Breast-feeding Education Program on Rates in the Early Postpartum Period and on Duration of Breast-feeding Year 2

The purpose of this project is to study the effect of a specific, planned, consistent breast-feeding education program on rates of breast-feeding initiation, and on duration of breast-feeding in the patient population. The study population includes all live births at the Claremore Indian hospital for one year from the onset of the study. The control will be a historical control, and will consist of all live births in the year prior to the onset of the study, inclusive of March 1, 1997 to April 30, 1998. During this period there were 640 live births. The goal of the study will be to reach the Healthy People 2000 goal of having 75 percent of mothers initiating breast-feeding, and keeping 50 percent breast-feeding for five to six months.

AGENCY SPONSOR: Office of Public Health

FEDERAL CONTACT: Fowler, Elizabeth A.
301-443-3024

PIC ID: 7141

PERFORMER: Indian Health Service
Rockville MD

EXPECTED DATE OF COMPLETION: 09/30/2000

Mental Health

Mental Health Service Delivery Model for Urban Native Americans: An Evaluation of Utilization Rates and Mental Health Treatment Factors

This project will address the Indian Health Service (IHS) mental health objective calling for a mental health care delivery system in urban areas. Results of the project will identify a potential model of mental health delivery applicable to urban areas.

AGENCY SPONSOR: Office of Public Health

FEDERAL CONTACT: Fowler, Elizabeth A.
301-443-3024

PIC ID: 5943

PERFORMER: California Area Indian Health Service
Sacramento, CA

EXPECTED DATE OF COMPLETION: 09/30/2000

Prevention Services

Alaska Native Teen Tobacco

The purpose of the Alaska Native Teen Tobacco Cessation Project is to (1) help the youth who participate in the project to quit tobacco; (2) motivate the youth to become tobacco prevention and cessation advocates in their communities; (3) determine the effectiveness of cessation camp model in helping youth to quit tobacco. If successful, further application of this model would be promoted. This is a three year project.

AGENCY SPONSOR: Office of Public Health

FEDERAL CONTACT: Fowler, Elizabeth A.
301-443-3024

PIC ID: 7128

PERFORMER: Indian Health Service
Rockville MD

EXPECTED DATE OF COMPLETION: 12/30/2002

Effectiveness of Evaluation of Systematic Implementation of Clinical Prevention Protocols for Chronic Disease Risk Reduction

This project will address health prevention and the reduction of chronic disease complications through development of a tracking system for use by the physicians and patients. This tracking system will serve as a model for tribes with health contracts.

AGENCY SPONSOR: Office of Public Health

FEDERAL CONTACT: Fowler, Elizabeth A.
301-443-3024

PIC ID: 5938

PERFORMER: Nashville Area Indian Health Service
Nashville TN

EXPECTED DATE OF COMPLETION: 09/30/2000

Evaluation of the Behavioral Risk Factor Surveillance System's Results and Their Applicability to the Native Population of Anchorage

This study will determine the relative accuracy, validity and reliability of the Behavioral Risk Factor Surveillance System (BRFSS) risk estimates of the Anchorage Native population, compared with data collected using other techniques that include: (1) door-to-door household surveys, (2) key informant surveys, and (3) intercept data collection from Natives seeking primary care services in Anchorage from the Alaska Native Medical Center and the Primary Care Center. The analyses are revealing those particular risk factors that appear to be most significantly misrepresented by the BRFSS. This factor, combined with a more clinical analysis of those factors that pose the greatest risks to the health and well-being of the Native community, will be used in determining which questions to include on the key informant survey. Due to the nature of the survey, a relatively concise instrument is required, and only those items holding a high priority on one or both of the selection criteria (i.e., representation problems with the BRFSS and high clinical/medical risk) will be included in the key informant survey instrument.

AGENCY SPONSOR: Indian Health Service

FEDERAL CONTACT: Fowler, Elizabeth A.
301-443-3024

PIC ID: 7137

PERFORMER: Indian Health Service
Rockville MD

EXPECTED DATE OF COMPLETION: 09/30/2000

Hyperlipidemia and Coronary Heart Disease (CHD) in Native Americans: Evaluation of Lipid Control Through a Pharmacist Managed Lipid Clinic

The purpose of this project is to evaluate the results of CV clinic coronary heart disease (CHD) risk management, counseling and aggressive medical nutritional therapy and pharmacological-therapeutic treatment of hyper-cholesterol in primary and secondary prevention in American Indian/Alaska Native (AI/AN) patients. The study will evaluate whether a pharmacist can effectively manage patients with dyslipidemias in comparison to usual care. In order to do this, the study will look at the proportion of patients enrolled in the CV clinic who meet target goals for total cholesterol, LDL cholesterol and triglycerides, compared to those receiving only the usual care. Secondly, the cost-effectiveness of the CV clinic will be evaluated. Lastly, changes in morbidity and mortality will be evaluated. If the findings of this evaluation show that the CV clinic is cost effective and successful in decreasing morbidity and mortality in the native population, this clinic could serve as a national prototype for other Indian Health Service (IHS) facilities.

AGENCY SPONSOR: Office of Public Health

FEDERAL CONTACT: Fowler, Elizabeth A.
301-443-3024

PIC ID: 7139

PERFORMER: Indian Health Service
Rockville MD

EXPECTED DATE OF COMPLETION: 09/30/2000

Infant/Child Restraint Usage and Program Effectiveness

This project will determine (1) the effectiveness of Billings Area Indian Health Service (IHS) car seat programs; and (2) how to increase the use of carseats. Study subjects, mothers of children under three years old, will be recruited while at the hospital and at well-child clinics. Methods to increase awareness of the benefits of using car seats will include “buckle-up” campaigns and encouraging tribal councils to pass and enforce seat-belt ordinances.

AGENCY SPONSOR: Office of Public Health

FEDERAL CONTACT: Fowler, Elizabeth A.
301-443-3024

PIC ID: 5529

PERFORMER: Indian Health Service
Rockville MD

EXPECTED DATE OF COMPLETION: 09/30/2000

Pueble of Zuni End Stage Renal Disease (ESRD) Quality of Life Survey

This study will assist the Pueblo of Zuni to measure the level of burden and quality life factors associated with end stage renal disease as it effects tribal members and their families.

AGENCY SPONSOR: Office of Public Health

FEDERAL CONTACT: Fowler, Elizabeth A.
301-443-3024

PIC ID: 6411

PERFORMER: Indian Health Service
Rockville MD

EXPECTED DATE OF COMPLETION: 09/01/2001

Study of the Impact of a Full-Time Community Health Nurse on the Health of Native American (Sioux) Patients with Hypertension & Prevention .....

This project will study the impact of a full-time community health nurse on the detection and follow-up of hypertension within a specific Native American tribe, the Sioux. The impact of having a full-time community health nurse on the prevention of and education cerebrovascular, cardiovascular and renal disease within this population will also be examined.

AGENCY SPONSOR: Office of Public Health

FEDERAL CONTACT: Fowler, Elizabeth A.
301-443-3024

PIC ID: 6413

PERFORMER: Aberdeen Area Indian Health Service
Aberdeen, SD

EXPECTED DATE OF COMPLETION: 09/01/2001

Utilizing the Indian-Specific Health Risk Assessment to Evaluate Community Health Promotion/Disease Prevention Programs

This project will: (1) produce a planning and assessment model for rural Alaska villages to develop a community behavior risk profile, (2) plan and implement appropriate intervention strategies, and (3) determine the impact of these interventions. It will collect baseline data through a community-wide health risk appraisal (HRA), and use model results to: (1) identify the most serious health risk behaviors, (2) plan appropriate interventions, (3) re-administer the HRA in the community after a trial period to determine its impact, and (4) conduct a workshop for other communities to facilitate program replication.

AGENCY SPONSOR: Office of Public Health

FEDERAL CONTACT: Fowler, Elizabeth A.
301-443-3024

PIC ID: 4996

PERFORMER: Southeast Alaska Regional Health Corporation
Sitka AK

EXPECTED DATE OF COMPLETION: 12/20/1999

Substance Abuse Treatment

Study of the Interaction of Persons Treated for Alcoholism with the Health Care Delivery System

This project will study and evaluate the results of alcohol treatment for Indians who abuse alcohol. The primary physician will focus on the overall health care delivery system. The methodology issues will be worked out initially for the population served by the Crow Agency Service Unit. Data retrieval, audit instruments and analytical strategies will be piloted for one to two years. The methodology will be refined and used in all service units.

AGENCY SPONSOR: Office of Public Health

FEDERAL CONTACT: Fowler, Elizabeth A.
301-443-3024

PIC ID: 6742

PERFORMER: Billings Area Indian Health Service
Billings, MT

EXPECTED DATE OF COMPLETION: 09/30/2000

National Institutes of Health

MISSION: To sponsor and conduct medical research that leads to better health for all Americans.

Evaluation Program

The National Institutes of Health (NIH) generates scientific knowledge that leads to improved health. This is done by conducting medical research in its intramural laboratories and by supporting research in universities, medical and health professional schools, and other health research organizations. NIH fosters the widespread dissemination of the results of medical research, facilitates the training of research investigators, and ensures the viability of the research infrastructure. The NIH Evaluation Program is an integral part of how NIH sponsors and conducts medical research.

Results based management is recognized as a basic principle for the sound and productive operation of government agencies and their programs. This is evidenced most notably by passage of the Government Performance and Results Act (GPRA) and by the considerable effort across the federal government to implement results based management mechanisms. With GPRA and other initiatives aimed at increasing public sector accountability (such as the Chief Financial Officers Act and the Government Management Reform Act), interest in the use of evaluation has increased steadily among NIH administrators and others, such as officials within the General Accounting Office, the Office of Management and Budget and the Department of Health and Human Services.

Philosophy and Priorities. The NIH Evaluation Program provides information to assist the NIH Director and the NIH Institute and Center (IC) Directors in determining whether NIH goals and objectives are being achieved and to help guide policy development and program direction. Evaluations are planned and conducted from two sources of funds: 1 percent evaluation set-aside funds used to fund trans-NIH projects, and IC program funds used for program evaluations for use by various committees, working groups, task forces, workshops, conferences, and symposia to assist the ICs in program management and development. This approach ensures that planning and priority setting specific to the mission of each IC are fully developed and implemented and that there is central leadership for developing crosscutting initiatives and promoting collaboration among the ICs.

NIH's major evaluation priority areas fall within three broad program areas: basic research, research training and career development, and facilities. NIH conducts evaluations in these areas to assess strategies and goals, develop performance measures and improve operations.

Policies and Operations. A distinguishing feature of the NIH Evaluation Program is the utilization of a variety of evaluation strategies that include the use of national advisory councils, boards of scientific counselors, consensus development conferences, and ad hoc committees that help to chart scientific directions and select the most promising research to support.

A two-tier system is used to review project requests that will use 1-percent evaluation set-aside funding. The first tier involves a review and recommendations by the NIH Technical Merit Review Committee (TMRC) on the technical aspects of project proposals and whether a project fits within HHS guidelines for use of the set-aside fund. The second tier involves the NIH Evaluation Policy Oversight Committee (EPOC), which considers TMRC recommendations, conducts policy level reviews, and makes final funding recommendations to the NIH Director or his designee.

Fiscal Year 1999 Evaluation Reports

Research

Customer Satisfaction and Research Involvement Among Applicants for NIH R01 and R29 Grants

This report was prepared by the Office of Extramural Research at the National Institutes of Health (NIH) and depicts a stratified random sample of 2,694 individuals who had applied to the NIH for an R01 or R29 grant in 1994. These applicants were surveyed to assess their satisfaction with the NIH's grant application and review process. Over 78 percent of respondents held PhDs or other research doctorates, the majority of which were in the biomedical sciences. Ninety-three percent of the respondents were working full-time in academic institutions, and 54 percent had received some type of NIH research funding by June 1997. Based on their experiences in applying for NIH grants since 1994, about 41 percent of the respondents were satisfied with the handling of their application to the NIH, 35 percent expressed mixed feelings, and 24 percent were dissatisfied. Not surprisingly, unfunded applicants showed greater dissatisfaction with the overall application and review process than funded applicants. The appropriateness of the scientific review group yielded the highest percentage of satisfied responses (47 percent) and timely receipt of the 'pink sheet' and notification of the NIH's funding decision elicited the strongest reactions from applicants. Approximately 54 percent of the applicants offered observations and suggestions for improvement that included: (1) modification of forms and submission practices; (2) increased use of electronic submissions and availability of forms in word processing formats; (3) shortened length of the application and reduction of the amount of information required; (4) use of more expert reviewers; (5) reduction of the length of time between application submission and the receipt of funding.

AGENCY SPONSOR: Office of the Director

FEDERAL CONTACT: Schaffer, Dr. Walter
301-435-2770

PIC ID: 6280

PERFORMER: Macro International, Inc.
Calverton, MD

Interagency Working Group Pilot to Assess the Feasibility of Developing and Maintaining an Inventory of Cancer-related Research Across the Federal Government

This project originally involved the design and pilot-test of a process for developing an inventory of cancer-related research activities across federal agencies. The goal was to assess both the feasibility and usefulness of developing the inventory. Anticipated benefits were the possibility for improved utilization and coordination of resources and the means to identify opportunities for collaborations and promising areas of research. In the course of assessing the availability of existing database information systems for cancer research, the project learned of a database under development for the federal Office of Science and Technology Policy. Known as RaDiUS, this data system is intended to be a comprehensive source of basic information on all research and development supported by the U.S. government. The project shifted direction to evaluate RaDiUS in terms of its success in its ability to identify a comprehensive set of relevant project records within specific cancer research areas (lung cancer, cancer and genetics). The accuracy and completeness of data supplied by RaDiUS within identified project records was also evaluated. RaDiUS data were compared to data acquired directly from several agencies to evaluate accuracy and comprehensiveness. Overall, findings of the research indicate that RaDiUS is currently the most comprehensive database available that lists U.S. Federal R&D efforts, and is a potentially useful tool in identifying cancer research across the Federal government.

AGENCY SPONSOR: National Cancer Institute

FEDERAL CONTACT: Middleswarth, Anne
301-496-5515

PIC ID: 6091

PERFORMER: NOVA Research Company
Bethesda MD

Training

Trends in the Early Careers of Life Scientists

This report extends the analyses of previous reports by examining the changes that have occurred over the last 30 years in graduate and postgraduate training of life scientists and the nature of their employment on completion of training. It also suggests reasons for the decrease in the number of young scientists applying for NIH grants. Findings indicate that the training and career prospects of a graduate student or postdoctoral fellow in the life sciences in 1998 are very different from what they were in the 1960s or 1970s. Today's life scientist will start graduate school when slightly older and take more than two years longer to obtain the PhD degree. Today's life science PhD recipient will be an average of 32 years old. Furthermore, the new PhD today is twice as likely as in earlier years to take a postdoctoral fellowship and thus join an ever-growing pool of postdoctoral fellows--now estimated to number about 20,000--who engage in research while obtaining further training and waiting to obtain permanent positions. It is not unusual for a trainee to spend five years--some more than five years--as a postdoctoral fellow. As a consequence of that long preparation, the average life scientist is likely to be 35-40 years old before obtaining his or her first permanent job. The median age of a tenured or tenure track faculty member is now about eight years more than that of the faculty member of the 1970s.

AGENCY SPONSOR: Office of the Director

FEDERAL CONTACT: Schaffer, Dr. Walter
301-435-2770

PIC ID: 6098

PERFORMER: National Academy of Sciences, National Research Council
Washington, DC

In-Progress Evaluations

Facilities

Full-Scale Evaluation of the Regional Primate Research Centers (RPRC) Program

The Regional Primate Research Center (RPRC) program represents a commitment by the National Institutes of Health (NIH) to the development and support of regional and National non-human primate research resources for biomedical and behavioral studies. This evaluation is intended to determine the optimum configuration of resources for non-human primate research programs.

AGENCY SPONSOR: National Center for Research Resources

FEDERAL CONTACT: Perrone, Barbara
301-435-0871

PIC ID: 6045.1

PERFORMER: James Bell Associates, Inc.
Arlington, VA

EXPECTED DATE OF COMPLETION: 12/20/99

Survey of Scientific and Engineering Research Facilities at Colleges and Universities

Since 1986 and every two years subsequently, the National Science Foundation (NSF) and the National Institutes of Health (NIH) have conducted the Survey of Scientific and Engineering Research Facilities. The availability and condition of biomedical research space directly affects the scope and quality of the biomedical research conducted at the Nation's colleges, universities, medical schools, hospitals and other research organizations. To address the need for information on the amount and quality of S&E research space, Congress mandated that the NSF gather this information and report it to Congress.

AGENCY SPONSOR: National Center for Research Resources

FEDERAL CONTACT: Taylor, Fred W.
301-435-0766

PIC ID: 6863

PERFORMER: National Science Foundation
Arlington, VA

EXPECTED DATE OF COMPLETION: 12/20/99

Research

Costs of Clinical Trials Study

The Cost of Cancer Trials Study (CCTS) is a study of cancer patients throughout the U.S. being conducted by RAND, a private, non-profit research institution based in Santa Monica, California, with principal funding and scientific guidance from the National Cancer Institute. This study will estimate the incremental costs of medical treatment provided as part of NCI- sponsored protocols. Incremental costs refers to the costs of additional medical resources, if any, provided to patients on protocols above and beyond those that would have been received in the absence of trial participation. The results from this study should be of interest to policymakers, insurers and healthcare decision makers trying to determine appropriate reimbursement for clinical trials. As secondary endpoints, patient satisfaction and health outcomes of patients in trials will be compared with those not in trials. The study will use a multi-stage study design to select 1,600 patients at 50-60 study sites among all of the institutions, clinics or practices in the U.S. that are participating in NCI-sponsored Phase II or III clinical trials. The patient sample will be obtained by randomly selecting patients who have enrolled in a clinical trial during a specified period of time at these study sites. Using cancer registries and chart reviews, a matched control group of cancer patients who did not enroll in a clinical trial will be sampled and followed. Using economic models of costs, the two groups will be compared to estimate the cost of trial participation.

AGENCY SPONSOR: National Cancer Institute

FEDERAL CONTACT: McCabe, Mary S.
301-496-6404

PIC ID: 7116

PERFORMER: Rand Corporation
Santa Monica, CA

EXPECTED DATE OF COMPLETION: 12/28/01

Planning and Development of the Early Childhood Longitudinal Study--Year 2000 Birth Cohort

The Early Childhood Longitudinal Study, Year 2000 Birth Cohort (ECLS-B) is sponsored by the U.S. Department of Education, National Center for Education Statistics, in collaboration with the National Center for Health Statistics, the National Institutes of Health, the Administration on Children, Youth & Families, the Department of Agriculture, and other Federal agencies. It is designed to provide detailed information about children's early life experiences, including children's health, development and care, and education from birth through first grade. Beginning in September 2000, over 12,000 nine- month-olds nationwide will be recruited into the ECLS-B. At this time, parents will be interviewed and infants will be observed to learn about their health and development. The study will follow the children and their families for at least six years, by which time most of the children will have reached first grade. Evaluation funds will help shape the ECLS-B into an important health planning, evaluation and research tool. Specifically, the funds will be used to supplement questions and assessments, including costs associated with question development, assessment of data collection methodologies, and field testing. Funds have been committed to support an oversample of twins, an oversample of very low birth weight (VLBW) infants, a self-administered questionnaire for resident fathers, and a self-administered pilot questionnaire for non-resident fathers who have some contact with the child. Data from the ECLS-B are expected to inform many government analyses and policy reviews, including program evaluation and research efforts to focus on infants, and variables that mediate the impact of service or intervention programs, or otherwise influence children's health in this country.

AGENCY SPONSOR: National Institute of Child Health and Human Development

FEDERAL CONTACT: Li, Rose Maria, Ph.D.
301-496-1175

PIC ID: 7115

PERFORMER: Department of Education, National Center for Educ Statistics
Washington, DC

EXPECTED DATE OF COMPLETION: 4/30/02

Planning Phase for an Evaluation of the NIDR Center Program

This project developed a study design for an evaluation of the National Institute of Dental Research (NIDR) center program.

AGENCY SPONSOR: National Institute of Dental and Craniofacial Research

FEDERAL CONTACT: Corrigan, Dr. James G.
301-496-6705

PIC ID: 5578

PERFORMER: National Institute of Dental Research
Bethesda, MD

EXPECTED DATE OF COMPLETION: 12/20/99

Population Centers Program Evaluation

For over three decades, the Demographic and Behavioral Sciences Branch (DBSB) has supported the Population Centers Program (PCP), which has provided infrastructure support for population research. Currently, 12 centers are supported nationwide. While the PCP has been critical in supporting the development of population research over these 30 years, it is clear that the needs and institutional context of the discipline have changed significantly over time. In response, the DBSB is evaluating how the PCP is meeting the needs of population researchers today, and whether there are different ways of structuring and competing the program to better serve the future of the science. The DBSB is recruiting a group of five eminent scientists to serve as consultants, and prepare background and summary papers, as well as recommendations, to assist the Branch in conducting the evaluation. Using a variety of data, these scientists will perform a needs assessment, evaluate the current status of the PCP, and prepare papers that summarize their findings and suggestions for modifying the program. The DBSB will convene two or three meetings over the course of a year to monitor progress and assess the need for additional data. The DBSB will also design a procedure for inviting public comment from those who want to express their views on the Center's program, and these comments will be shared with the consultants. Based on the recommendations made by individual consultants, and discussions at meetings of the consultants and other scientists, the DBSB will work with Institute staff to translate the suggestions into appropriate NICHD mechanisms and policies.

AGENCY SPONSOR: National Institute of Child Health and Human Development

FEDERAL CONTACT: Bachrach, Christine A., Ph.D.
301-496-1174

PIC ID: 7119

PERFORMER: National Institute of Child Health and Human Development
Bethesda, MD

EXPECTED DATE OF COMPLETION: 7/1/00

Surgeon General's Report on Oral Health

The Surgeon General's (SG's) report will provide an opportunity to describe oral health and provide the backdrop to present the case for the critical inter-relationship between oral health and general health.

AGENCY SPONSOR: National Institute of Dental and Craniofacial Research

FEDERAL CONTACT: Kleinman, Dr. Dushanka
301-496-7716

PIC ID: 6861

PERFORMER: National Institutes of Health
Bethesda, MD

EXPECTED DATE OF COMPLETION: 1/20/00

Vaccine Development: Establishing Priorities for the United States for the 21st Century

This evaluation will undertake a detailed assessment of vaccine research and development needs and priorities for the upcoming decade. The committee will then apply the model to general priorities for domestic vaccine development for the next ten to twenty years.

AGENCY SPONSOR: National Institute of Allergy and Infectious Diseases

FEDERAL CONTACT: Rabinovich, D. Regina, M.D.
301-402-2126

PIC ID: 5984

PERFORMER: National Academy of Sciences
Washington, DC

EXPECTED DATE OF COMPLETION: 12/31/99

Training

Evaluation of NIH Post-doctoral Trainees and Fellows

This study is part of a long-term evaluation effort directed at examining the extent to which the objectives of the National Institutes of Health (NIH) National Research Service Award (NRSA) pre-doctoral and post-doctoral training programs are being achieved. Using extant data, the focus of this project is to develop a profile of NRSA post-doctoral award recipients and determine what portion of former NRSA post-doctoral trainees and fellows successfully pursue health-related research or training careers.

AGENCY SPONSOR: Office of the Director

FEDERAL CONTACT: Schaffer, Dr. Walter
301-435-2770

PIC ID: 6285

PERFORMER: Vanderbilt University, Institute for Public Policy Studies
Nashville, TN

EXPECTED DATE OF COMPLETION: 12/20/99

Evaluation of Simplification of Human Resources Management System at the Nation Institutes of Health

The NIH will engage the services of an expert organization to develop criteria, conduct evaluations and provide program development support. The Secretary, DHHS, and the director, NIH, will jointly appoint a panel of distinguished scientists and administrators to review the contractor evaluations and the impact of these delegations on the NIH research programs.

AGENCY SPONSOR: Office of the Director

FEDERAL CONTACT: Benowitz, Stephen C.
301-496-3592

PIC ID: 6862

PERFORMER: National Academy of Public Administration
Washington, DC

EXPECTED DATE OF COMPLETION: 10/30/01

Evaluation of the National Institute of Mental Health (NIMH) National Research Service Awards for Predoctoral Individual M.D./Ph.D. Fellows

To address research training needs related to the fields of mental health, neuroscience, alcohol abuse, and drug abuse, the Alcohol, Drug Abuse, and Mental Health Administration established a National Research Service Award (NRSA) individual fellowship mechanism in 1989 for training physicians and scientists. After rejoining the National Institutes of Health (NIH) in 1993, the NIMH, along with the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the National Institute on Drug Abuse (NIDA), elected to continue this mechanism. The objectives of this fellowship program are to increase the numbers of physicians and scientists trained in, and conducting, biomedical and behavioral research in areas related to mental illness and addictions. Because this fellowship mechanism is young, and most participants are still in training, this is an optimal time to establish a tracking system which builds a framework for measurement of program performance and future periodic assessments of the program. The objectives of this project are to assess the impact of this support mechanism on: (1) changes in the numbers of M.D.s, and Ph.D.s conducting clinical and basic research in neuroscience, mental health, and behavioral sciences, and mental health services research; and (2) the specific areas of science in which fellowship graduates conduct research.

AGENCY SPONSOR: National Institute of Mental Health

FEDERAL CONTACT: Babich, Karen
301-443-4335

PIC ID: 6096

PERFORMER: National Institute of Mental Health
Rockville, MD

EXPECTED DATE OF COMPLETION: 9/30/00

Study of National Needs for Biomedical and Behavioral Research Personnel

The National Academy of Sciences (NAS) is establishing a study committee which will direct activities related to the development of estimates of future needs for biomedical and behavioral research personnel. Using estimates of future needs, the committee will make recommendations concerning the size and composition of the National Research Service Awards (NRSA) research training programs.

AGENCY SPONSOR: Office of the Director

FEDERAL CONTACT: Schaffer, Dr. Walter
301-435-2770

PIC ID: 4664.1

PERFORMER: National Academy of Sciences
Washington, DC

EXPECTED DATE OF COMPLETION: 1/20/00

Office of the Assistant Secretary for Planning and Evaluation

MISSION: To provide analytical support and advice to the Secretary on policy development and assist the Secretary with the development and coordination of department wide program planning and evaluation activities.

Evaluation Program

The Assistant Secretary for Planning and Evaluation (ASPE) functions as a principal advisor to the Secretary on policy development and, in this capacity, conducts a variety of evaluation and policy research studies on issues of national importance. ASPE also is responsible for department wide coordination of legislative, planning, and evaluation activities. In its evaluation coordination role, ASPE has the following tasks:

  • Provide annual guidance to all HHS agencies and staff offices regarding evaluation priorities, procedures, and review requirements.
  • Review evaluation priorities proposed by HHS agencies, providing advice about the focus or method of proposed projects and identifying opportunities for collaboration, and effective use of resources.
  • Prepare planning and summary reports on evaluation activities as required by Congress.

Through the departmental evaluation planning process, ASPE has the capacity to identify crosscutting program or policy issues of particular concern to the Secretary and specific program and policy areas not covered by the HHS Agency evaluation plans. In these instances, ASPE initiates evaluations or collaborates with the agencies to conduct evaluations or policy assessments. For example, in recent years, ASPE has initiated projects to develop cost estimates for health financing issues in general, and specifically for the Medicare and Medicaid programs; the effects of managed care expansion on public health infrastructure; welfare-to-work approaches; long-term care alternatives; and studies evaluating alternative services for children at risk of harm from drug abuse, crime, child abuse, and other pathologies.

Another continuing evaluation objective of ASPE is to support and promote the development and improvement of data bases that HHS agencies and ASPE use to evaluate health care programs and health trends. For example, ASPE has been the major initiator in collaboration with the National Center for Health Statistics at the Centers for Disease Control and Prevention of the first comprehensive survey of people with disabilities in the United States. The first component of these new data was completed in FY 1996, and national prevalence data on disability are now available. The ASPE co-chairs and provides support to the HHS Data Council, which is charged with integrating key national surveys, such as linking health status indicators with indicators of well-being. The Department needs more comprehensive data sources to assess anticipated transformations in health and human services.

Finally, ASPE uses evaluation funds to promote effective use of evaluation-generated information in program management and policymaking. The latter is accomplished through the dissemination of evaluation findings and other activities, such as providing technical assistance to agencies in the development of performance measures.

Fiscal Year 1999 Evaluation Reports

Disability, Aging and Long-Term Care Policy

A Descriptive Analysis of Patterns of Informal and Formal Caregiving among Privately Insured and Non-Privately Insured Disabled Elders Living in the Community

Long-term care (LTC) expenditures account for almost 12 percent of total personal health expenditures--a threefold increase since 1960--leaving large numbers of elderly Americans vulnerable to catastrophic expenditures that can rapidly deplete their income and life savings. Limited public funding for long-term care expenses, coupled with tax incentives for individuals and companies to obtain private LTC policies, has heated up sales in the burgeoning private long-term care insurance market. This research was designed to answer such questions as: Does private LTC represent a "good buy?" How are benefits being used, and do claimants feel they are getting good value for the premiums they pay?" This research was designed to answer these questions and to provide basic socio-demographic and service utilization profiles for disabled private LTC insurance policyholders, and to compare such data and findings to the experiences of non-insured disabled community-dwelling elders. Finally, a discussion is provided on the implications of such findings on the service delivery system as well as on the design of private and public LTC programs and policies.

AGENCY SPONSOR: Office of Disability, Aging, and Long-Term Care Policy

FEDERAL CONTACT: Doty, Pamela
202-690-6613

PIC ID: 6399.1

PERFORMER: Lifeplans
Waltham MA

Medicare's Post-Acute Care Benefit: Background, Trends, and Issues to be Faced

A major policy response to the escalation in expenditures for Medicare's post-acute care benefits--from about $2.5 billion in 1986 to more than $30 billion in 1996 caused a change from retrospective cost-based reimbursement to case-mix adjusted prospective payment. Among the concerns is that the impact of these changes on cost, quality, and access is unknown. The impact of these changes on is unknown somehow failed to address many other cost, quality, and access concerns. Foremost among these is the concern that Medicare continues to treat the different types of post-acute care providers differently--in terms of payment, eligibility, coverage, and certification--even though the different types of providers may be becoming more and more similar in the types and intensity of services they deliver, as well as the types of patients they serve. Other concerns include policy-induced incentives to discharge patients for financial rather than quality of care reasons and access problems faced by heavy-care patients. This study examined recent changes in post-acute care payment policy, identified potential problems with Medicare's post-acute care services and explored promising solutions.

AGENCY SPONSOR: Office of Disability, Aging, and Long-Term Care Policy

FEDERAL CONTACT: Harvell, Jennie
202-690-6613

PIC ID: 7365.1

PERFORMER: Urban Institute
Washington, DC

Preliminary Data from a Survey of Employers Offering Group Long-Term Care Insurance to Their Employees

This interim report provides timely information about current practices in the employer group Long-term care (LTC) insurance market that can inform federal policy makers and employers in deciding how to construct a group LTC insurance offering. It summarizes data collected from a survey of employers offering group long-term care insurance to their employees. The survey is part of a study funded by the Assistant Secretary for Planning and Evaluation (ASPE), Department of Health and Human Services (HHS) investigating current products and best practices in the employer group LTC insurance market. The survey found that among employers offering the product, access to coverage is greater in the employer market than in the individual market. The survey also found that surveyed employers usually limited the number of benefit choices considerably. For example, a majority offered three or fewer benefit amount options. Nearly all employers used a single LTC insurer. The data also suggests that the benefit features of employer group plans generally resemble individually purchased policies. While these findings may be indicative of trends in the employer LTC insurance market, the sample was not large enough to justify a claim that results are representative of all medium and larger employers offering LTC insurance. The final report of the survey's findings can be found in PIC ID #6718.1.

AGENCY SPONSOR: Office of Disability, Aging, and Long-Term Care Policy

FEDERAL CONTACT: Cutler, John
202-690-6443

PIC ID: 6718

PERFORMER: The Lewin Group
Fairfax, VA

Risk Selection Among SSE Enrollees in TennCare

Risk selection in managed care plans occurs when the healthcare needs of beneficiaries enrolled in a specific plan differ systematically from risk assumption built into the premium calculation methodology. When this occurs, state administrators of Medicaid should adjust payments to managed care plans to ensure that each plan's payment accurately reflects the needs of its enrollees. Without such a payment system, problems for plans and beneficiaries are likely to arise. Plans with adverse selection (that is, a disproportionately large number of high-need beneficiaries) are likely to lack the resources required to deliver adequate care to their enrollees, forcing them, perhaps, eventually, to drop out. Plans with favorable selection (a disproportionately large number of low-need beneficiaries) will be paid more than necessary to provide care. The disability supplement to the existing Health Care Financing Administration (HCFA) evaluation of Medicaid 1115 waiver demonstrations in five states adds a disability focus to the study of the TennCare program in Tennessee. This supplement examined the experiences of disabled adults (physically disabled, mentally ill, mentally retarded, or developmentally disabled) and disabled children enrolled in the TennCare and TennPartners programs. The project conducted: (1) in-depth qualitative analyses of the state's experience in enrolling individuals with disabilities into managed care systems, and (2) quantitative analyses to examine costs and utilization data for these populations. In addition, the supplement conducted a survey of disabled consumers to examine issues of satisfaction, quality, health status and functioning. Findings indicated that risk selection is difficult to prevent or reduce, especially when attempting to maintain continuity of care in the transition to managed care Alternative reimbursement options, however, require the development of good data. See PIC ID 6289, 6289.1, 6166, and 6166.1.

AGENCY SPONSOR: Office of Disability, Aging, and Long-Term Care Policy

FEDERAL CONTACT: McKay, Hunter
202-690-6613

PIC ID: 6289.2

PERFORMER: Mathematica Policy Research, Inc.
Plainsboro, NJ

State Welfare-to-Work Policies for People with Disabilities: Changes since Welfare Reform

This report was prepared by The Urban Institute for the Office of the Assistant Secretary of Planning and Evaluation (ASPE). The purpose of this study is to determine the extent to which states have used the flexibility provided under the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) to change their welfare-to-work policies as applied to individuals with disabilities and caregivers. This is the first attempt to provide a nationwide overview of welfare- to-work policies for individuals with disabilities and caregivers. Key findings on work participation and time limit policies show that: (1) the majority of states are using the flexibility provided under PRWORA to increase participation in these programs among person with disabilities; (2) states that have 'broadened' participation requirements but have stopped short of requiring 'universal' participation have done so in a variety of ways; (3) states requiring universal participation among welfare clients use individualized service planning strategies that emphasize recipients' capabilities and acknowledge that the path to self-sufficiency may be long; and (4) states are in the early stages of assessing who among those on welfare may need assistance beyond 60 months.

AGENCY SPONSOR: Office of Disability, Aging, and Long-Term Care Policy

FEDERAL CONTACT: Marton, William
202-690-6613

PIC ID: 7245

PERFORMER: Urban Institute
Washington, DC

Health Policy

A Longitudinal Model of Health Insurance: Employer Sponsored Insurance

To improve our understanding of the trends in health care coverage and costs, available data is being reevaluated. For years, this data has been used to estate costs and coverage, to identify trends, and to form policy regarding health insurance and health benefits. This report was initiated by ASPE to develop a longitudinal model for tracking the key indicators of employer sponsored insurance (ESI) to facilitate the identification of trends and to offer policy makers a set of consistent single point estimates based on analysis of available data sources. The subsequent longitudinal model developed by the research team is based on the March Current Population Surveys, from March 1990 through March 1998 (CY 1989 through CY 1997). Specific trends to be tracked include, but are not limited to: the overall level of employer sponsored insurance in the US (both counts and as a proportion of the population); the extent of employer sponsored insurance in own name (policy holder prevalence); the extent of employer sponsored insurance as a dependent; the prevalence of dual policy holder families. The authors had to adjust the Current Population Survey (CPS) data because changes in survey and sample frame over time make it less useful for longitudinal study without adjustments. The adjustments were made to the historical data in order to be able to a look at trends in employer sponsored coverage from 1990 to the present. The report concludes by stating that the current set of adjusted files appears to address the problems caused by survey and sample frame changes, and generates coverage estimates roughly consistent with those implied by the Survey of Income and Program Participation.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Greenberg, George
202-690-7794

PIC ID: 7295

PERFORMER: Actuarial Research Corporation
Annandale, VA

All Under One Roof: Mixed -Status Families in an Era of Reform

This report documents the prevalence of mixed immigration status families and discusses some of the immigration and citizenship policies that drive their formation. It identifies a number of the challenges that mixed-status families pose for achieving the goals of recent welfare and illegal immigration reform laws. It explores how recent curbs on noncitizens' use of public benefits may have the unintended effects of "chilling" citizen children's use of benefits. The report examines how recent laws limited undocumented immigrants' ability to adjust from illegal to legal status, effectively perpetuating certain mixed-status families. They do so by freezing a growing number of parents and children into differing statuses: parents as undocumented immigrants or "outsiders", children as citizens or "insiders." The citizen children in these families may not receive the same opportunities as other citizen children due to their parents' legal status. One effect, according to the report, is to treat citizen children in mixed-status families as second-class citizens. One ready solution to this problem would be to eliminate birthright citizenship. However, its adoption would signal a shift toward the approach taken by many European nations, which treat not just newcomers but also their children as outsiders, thereby perpetuating a type of hereditary disadvantage that departs from U.S. historical tradition.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Sanches, Linda
202-690-7233

PIC ID: 7370.2

PERFORMER: Urban Institute
Washington, DC

Analysis of Children's Health Insurance Patterns: Findings from the SIPP Executive Summary

This report summarizes working using the 1992 panel of the Survey of Income and Program Participation (SIPP) to provide the most detailed look yet at the dynamics of health insurance coverage among children and the relationship between Medicaid eligibility and insurance coverage. The findings indicate from October 1992 to September 1994, between 12.4 and 13.3 percent of children under 19 were uninsured at any one point in time, with one in four children (27.1 percent) uninsured for some period of time over the two years. the findings highlight the importance of shifting some attention from studying why children do not enroll in Medicaid to the question of why children lose Medicaid coverage when they may still be eligible. The findings highlight how Medicaid eligibility policy affects the relationships among income, child age, and coverage. The findings also highlight the substantially lower participation rates for children who are not cash assistance participants. This reinforces the importance of strong outreach to achieving high levels of CHIP participation and highlights ways of targeting outreach to reach diverse subsets of children. The findings also highlight the importance of not just enrolling children in Medicaid or CHIP but also retaining them in the programs.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Stewart, Robert
202-690-7273

PIC ID: 7355

PERFORMER: Mathematica Policy Research, Inc.
Washington, DC

Analysis of Prescription Drug to Over-the-Counter (Rx-to-OTC) Switch Movement

Approximately 600 over-the-counter (OTC) products currently available use ingredients and dosages available only by prescription 20 years ago. While there has been a steady stream of OTC switches since the mid-1970s, the number of switches has accelerated in recent years. Between 1988 and 1994 there were 14 switches, while in the last three years there were at least 19 switches. There are a number of possible reasons for this trend, including: (1) a growing emphasis on individual autonomy and self-help; (2) a trend toward deregulation in the U.S.; (3) healthcare cost containment efforts; and (4) pharmaceutical industry self-interest /profit. The issue of Rx-to-OTC switching deserves considerable attention because of the large number of people who could be affected by the trend, including consumers, pharmaceutical companies, physicians, pharmacists, and payers. The purpose of this project was to provide a comprehensive review and analysis of the impact of the Rx-to-OTC switch movement, particularly the more recent changes, in order to inform policy and define relevant research questions. The study contains a literature review on the subject; a summary of interviews with such key informants as pharmacists, consumers, and physicians; data analyses providing evidence of the magnitude of OTC sales and the importance of recent switch drugs within the OTC market; analyses related to the impact of OTC switch drugs on clinical practice patterns; and data from state Medicaid plan coverage of OTCs.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Bush, Laina
202-260-7329

PIC ID: 6723

PERFORMER: Northwestern University, Center for Health Services Policy
Evanston IL

Assessing the Performance of Organ Transplant Programs: Liver and Heart Transplantation

In its role under the National Organ Transplant Act as the responsible steward of the program of solid organ transplantation in the United States, the Department of Health and Human Services has carried out analyses of the three critical issues in transplantation... (1) What is the likelihood that, having been declared a transplant patient by being placed on a waiting list, the patient will actually receive an organ within a reasonable amount of time, say one year? (2) What is the likelihood that the patient will, instead, die while awaiting transplantation? (3) And what is the probability that the patient will still be alive one year after having been placed on the waiting list, whether or not he or she received a transplant? The findings indicated in both liver and heart transplantation, about two-thirds of the deaths within a year of listing occur while awaiting the transplant. The two measures of mortality are strongly correlate, with about 50% of the variation among centers in risk-adjusted survival accounted for by risk-adjusted mortality on the waiting list. In contrast, there is little correlation between the risk-adjusted rate of transplantation and risk-adjusted survival, none in the case of the liver. This reinforces the point that the early performance of a transplant is not necessarily the best care that can be provided to a patient. The best care consists of a broad constellation of practices of the listing center and of other hospitals and care-givers to which the patient is subjected while awaiting transplantation, as well as during and after the transplantation itself.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Krakauer, Henry
202-690-7771

PIC ID: 7354

PERFORMER: Office of the Assistant Secretary for Planning and Evaluation, Office of Health Policy
Washington, DC

Baseline Information for Evaluating the Implementation of the Health Insurance Portability and Accountability Act of 1996: Final Report

The Health Insurance Portability and Accountability Act (HIPAA) ensures access to insurance for some employer groups and individuals who previously were unable to purchase adequate coverage. The Department of Health and Human Services is required to report to Congress on the effects. Therefore the Health Care Financing Administration contracted with RAND and the Institute for Health Policy Solutions (IHPS) to develop the contextual information needed for an evaluation and to develop a design for the evaluation. Four central tasks were accomplished and reported in this final report: (1) developed a database which describes the regulatory environment in each state prior to HIPAA to measure regulatory actions states have taken to comply with HIPAA's requirements; (2) reviewed the literature to address issues that have arisen during HIPPA's implementation and summarized the expected effects of HIPAA's provisions; (3) reviewed the strengths and weaknesses of extant data that might be used in the HIPAA evaluation and (4) developed a plan to evaluate the effects of HIPAA on the accessibility and affordability of insurance in the group and individual insurance markets.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Finan, Stephen
202-690-7387

PIC ID: 7358

PERFORMER: Rand Corporation
Santa Monica, CA

Chartbook on Children's Insurance Status: Tabulations of the March 1998 Current Population Survey December 1998

This chartbook examines demographic and other characteristics of insured and uninsured children in the United States. It is based on data from the March 1998 Current Population Survey (CPS) and reflects children's insurance status during calendar year 1997. For the purposes of this chart book, the term "children" applies to all U.S. citizens and non-citizen residents under age 18. Key findings include: 10.7 million children, 15% of the population under age 18, are uninsured. In the March 1997 survey 10.6 million children or 15% were uninsured; 45 million children (63%) are covered under employer-sponsored insurance. This is consistent with the proportion of individuals in the overall population who are insured through an employer.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Taplin, Caroline
202-690-7906

PIC ID: 7356

PERFORMER: Office of the Assistant Secretary for Planning and Evaluation, Office of Health Policy
Washington, DC

Enabling Services Methodology Workshop

Enabling services was defined in a previous study as "services that facilitate access to medical care and/or support individuals in managing medical conditions". This project sought to address enabling services issues by: (1) exchanging information regarding what is known and unknown about enabling services in primary care settings, particularly in managed care environments, costs, efficacy, cost-effectiveness and new research efforts; (2) identifying key policy questions related to enabling services, particularly as used in managed care settings; (3) identifying major methodological questions that studies of these services present, both generally and in managed care settings, and strategies for overcoming them; and (4) developing a broad-based research agenda for consideration by the many public and private sector organizations which pay for, or otherwise have interests in, these services. The report presents findings, identifies questions regarding enabling services from the perspectives of various stakeholder groups, and considers strategies and approaches to addressing questions about enabling services.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Taplin, Caroline
202-690-7906

PIC ID: 6750

PERFORMER: The Lewin Group
Fairfax, VA

Linking State-Level Health Expenditure and Utilization Data to Identify Sources of Variation in Health Service Prices, Utilization, and Expenditures

The debate over comprehensive health reform in 1993 and 1994 revealed many strengths and weaknesses in the U.S. health care system. The policy development process underlying that debate exposed the limits of collective analytic capacity to explain the implications of expected changes in our health system. Due to budget constraints, the research community is severely limited in supporting state-specific estimates and data. This Urban Institute report accesses the combination of the expenditure data from The Health Care Financing Administration, with utilization data from The Health Resources and Services Administration to yield state- and service-specific prices that are analytically meaningful. The major finding is that the empirical models at the state level performed reasonably well - over 80% of the variance in the inpatient dependent variables (prices, utilization, and expenditures) is explained, as well as over 50% of the variance in these variables for outpatient services. This kind of model could be useful for both federal and state policy analysts to analyze market trends and to stimulate the effects of proposed policies.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Greenberg, George
202-690-7794

PIC ID: 7248

PERFORMER: Urban Institute
Washington, DC

The Child Health Insurance Program: Early Implementation in Six States

Research has demonstrated that children with health insurance coverage have greater access to medical care than those without coverage. On average, those with health insurance visit doctors more frequently than those without coverage. A 1993 survey, for example, found that of all children who had no physician visits in the past year, 39 percent were uninsured compared to 20 percent of children with private coverage. Children with health insurance coverage pay fewer visits to the emergency room in an average year than those without coverage. Those with health insurance develop fewer chronic illnesses, and those they do develop are treated more successfully than the chronic illnesses of uninsured children. To help reduce the number of uninsured children and to increase their access to medical care, Congress established, in 1997, a new Children's Health Insurance Program (CHIP) as Title XXI of the Social Security Act. Intended to supplement--not supplant--Medicaid, CHIP is designed to find and enroll "targeted low-income children" whose family income puts them above the Medicaid eligibility threshold, but below an income level that makes private health insurance premiums affordable. This study was designed to understand and document the decisions in six States regarding the: (1) planning process; (2) key factors affecting the program design in their initial plans submitted to HHS; (3) CHIP program design as a separate State-initiated program, a Medicaid expansion, or a combination; (4) choice of income eligibility levels; (5) parameters of State-initiated health insurance programs implemented prior to CHIP; and (6) implementation of specific features of their CHIP programs during the early months.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Taplin, Caroline
202-690-7906

PIC ID: 6308

PERFORMER: American Institutes for Research
Washington, DC

Trends in Noncitizens' and Citizens' Use of Public Benefits Following Welfare Reform: 1994-97

This report uses the Census Bureau's Current Population Survey (CPS) to document national trends in immigrants' use of public benefits in the period following welfare reform. Specifically, it examines changes in participation between 1994 and 1997 reflected by the March CPS. It is emphasized that most legal immigrants and refugees remained eligible for welfare and Medicaid benefits throughout the period examined (1994 through 1997). The principal findings are: (1) use of public benefits among noncitizen households fell more sharply (35 percent) between 1994 and 1997 than among citizen households (14 percent); (2) refugees experienced declines (33 percent) that were at least as steep as those within the noncitizen population; (3) for low-income populations (i.e., with incomes below 200 percent of poverty), program usage also fell faster for noncitizen than citizen households; (4) when welfare use among all households is examined, noncitizen participation levels were higher than citizens' in both 1994 and 1997, but poor households (i.e., with incomes under 200 percent of poverty), noncitizens' participation rates in 1994 were no different from those of citizens; by 1997, however, levels had declined so that noncitizens had lower participation rates than citizens; (5) neither naturalization nor rising incomes accounted for a significant share of noncitizens' exits from public benefit use.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Sanches, Linda
202-690-7233

PIC ID: 7370.1

PERFORMER: Urban Institute
Washington, DC

Using National Survey Data to Analyze Children's Health Insurance Coverage: An Assessment of Issues

The purpose of this report is to discuss key analytic issues in the use of national survey data to estimate and analyze children's health insurance coverage. One goal was to provide staff in the Office of the Assistant Secretary for Planning and Evaluation (ASPE) with information that will be helpful in reconciling or at least understanding the reasons for the diverse findings reported in the literature on uninsured children. The second major objective was to outline for the broader research community the factors that need to be considered in designing or using surveys to evaluate the number and characteristics of uninsured children. The single most important lesson learned from the review, according to the report, is how much estimates of the number and characteristics of uninsured children are affected by measurement error. Until progress is made in separating the measurement error from the reality of uninsurance, policy solutions will continue to be inefficient and our ability to measure our successes will continue to be limited.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Taplin, Caroline
202-690-7906

PIC ID: 7357

PERFORMER: Mathematica Policy Research, Inc.
Washington, DC

Human Services Policy

Adolescent Decision Making: Implications for Prevention Programs

Efforts to reduce teen marijuana use, smoking and pregnancy are not new, but they are now being debated in a policy climate characterized by frustration at past attempts to address teen behavior and renewed efforts to take strong actions to reduce these behaviors. The role of decision making processes in these interventions is a topic that has generated a substantial core of new research. This project convened a January workshop and prepared a summary report to: 1)identify the major lessons learned from the last decade of research on adolescent decision making, particularly as they bear on efforts to reduce behavior among adolescents; 2)discuss the results of research on efforts to intervene in adolescent behaviors; and 3)discuss the implications of this research for alternative approaches to reducing behavior among the Nation's youth, particularly in the areas of substance abuse and sexuality. The report covers the following topics: the decision-making framework, the world of adolescence, media influences, programs for adolescents, and issues for youth programs.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Stagner, Matthew
202-690-5653

PIC ID: 6877

PERFORMER: National Academy of Sciences, Board on Children and Families
Washington, DC

Blending Perspectives and Building Common Ground

Many in the child welfare field have recognized for years that substance abuse is central to child welfare issues. But with the implementation of the Adoption and Safe Families Act and renewed emphasis on achieving permanency for children in the child welfare system, finding effective ways to address concurrent substance abuse and child maltreatment problems in families takes on renewed importance. This report grew out of a request by the Congress for more information to guide Federal policies that would allow child welfare agencies and partners in the substance abuse treatment field to better address the needs of parents whose substance abuse problems rendered them unable to care for their children. This report fulfills the legislative mandate that requested the Department of Health and Human Services to: describe the extent and scope of the problem of substance abuse in the child welfare population; the types of services being provided; the outcomes resulting from the provision of such services; and to include recommendations for any legislation that may be needed to improve coordination in providing such services to such population. The findings and conclusions reached by the report indicate: it is clear that throughout the child welfare system, but especially with respect to children in foster care, alcohol and other drug abuse is recognized as a major contributing factor to child neglect and abuse and as one of the key barriers to family reunification; timely substance abuse services are key to achieving permanency for children; collaboration between child welfare and substance abuse treatment agencies must be improved.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Radel, Laura
202-690-5938

PIC ID: 7100

PERFORMER: Office of the Assistant Secretary for Planning and Evaluation, Office of Health Policy
Washington, DC

Enhancing the Well-Being of Young Children and Families in the Context of Welfare Reform: Lessons from Early Childhood, TANF, and Family Support Programs

Roughly two-thirds of the recipients of federally-subsidized cash assistance are children, nearly half of whom are under the age of six. While such children grow up in an environment which puts them at risk, a decade of cumulative research suggests that child development and family support programs can make a difference. This report identifies and presents profiles of promising Federal, State, and/or community-based health and human services programs believed to be enhancing the health and development of children in the context of welfare reform. It seeks to answer three questions: How are child development and family support programs serving low-income families with young children responding to new welfare policies and practices? What kinds of partnerships (e.g., state-local, public-private, interagency) are developing between those serving low-income families with young children and those implementing welfare changes? What opportunities and challenges are emerging for early childhood programs and agencies implementing welfare changes as they strive to improve outcomes for both adults/parents and young children? The report examines case management strategies, child assessment programs, links between pre-kindergarten and child care programs, school-readiness programs, assistance for families who are coping with domestic violence, substance abuse, and other risk factors, and other workings of these programs.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Moorehouse, Martha
202-690-6939

PIC ID: 6754

PERFORMER: Mathematica Policy Research, Inc.
Plainsboro, NJ

Estimated Effects of the Optional Review of Child Support Orders for TANF Cases

The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 made the review and modification of child support awards for those receiving welfare assistance optional, a change from prior law which required such reviews every three years. Given that States now have a policy choice, this project sought to inform that choice by developing national estimates of the financial effects of not reviewing child support awards for welfare recipient families on State child support collections. This project provided estimates of the financial effects on the Federal and State governments (how such a discontinuance would affect child support offsets to cash assistance payments.) First, the study compared the two policy regimes, estimating government savings from several sources. Then these estimated savings were combined with estimates of the cost of reviewing and modifying orders to get a total net fiscal effect. Finally, the study examined the separate effects on each state and the federal government, factoring in changes in incentive payments. The study pointed out that the effects on governmental revenues are not the only relevant factors to consider in evaluating optional versus mandatory child support award reviews. For example, if mandatory review increases collections but they accrue to the resident parent family rather than the government, the policy may still be advantageous in terms of increasing the well-being of economically vulnerable families.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Mellgren, Linda
202-690-6806

PIC ID: 6749

PERFORMER: Institute for Research on Poverty
Madison WI

Evaluating Welfare Reform: A Framework and Review of Current Work

The Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996 changed the nation's social welfare system by replacing a federal entitlement program for low-income families called Aid to Families with Dependent Children (AFDC) with state-administered block grants, the Temporary Assistance for Needy Families (TANF) program. The Office of the Assistant Secretary for Planning and Evaluation (ASPE) of the Department of Health and Human Services (DHHS) asked the National Research Council to convene a panel to study and recommend the best strategies for evaluating the effects of welfare reform programs and the data needs for conducting useful evaluations. The interim report from the panel made the following recommendations that were consistent with HHS's research agenda: (1) DHHS should be proactive in identifying important current and emerging issues for welfare policies at both federal and state levels, a strategy which may, in turn, lead the way to establishing priorities for investment in data and research. (2) DHHS should define the key populations of interest for welfare policy analysis in its research agenda and assure that its grant and contract research programs adequately cover all important population groups for welfare reform. In particular, to consider the effects of changes in welfare policies on the outcomes of low-income populations, it is important to study not only those who leave the system but those who stay as well as potential applicants who are diverted from programs or who do not apply. (3) DHHS should make improving capabilities for data collection and research on social welfare programs on both state and federal levels a priority. (4) DHHS should exercise leadership in working with states, localities, and research organizations to achieve both intra- and inter-state comparability of data and research on the effects of welfare reform. (5) DHHS should document TANF policies in each state and localities.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Hauan, Susan
202-690-8698

PIC ID: 7145.1

PERFORMER: National Academy of Sciences
Washington, DC

Exits from Welfare and Local Entry-Level Labor Markets

The current debate surrounding welfare reform pits those who view long-term welfare participation as a problem of "welfare dependency" resulting from poor work attitudes against those who view it as a problem of "working poverty" with poor, time- constrained single mothers using welfare to supplement low-wage and contingent employment. Presented in this report are estimates of the relative influence of individual characteristics, family structure and local entry-level labor market conditions on welfare durations and transitions into work. Contrary to previous research, the findings suggest that: (1) local labor market conditions are more important than individual and family level factors in predicting exits from welfare; (2) most women on welfare are working before, during and after a welfare spell; and (3) long-term, intermittent welfare participation may be more accurately understood as a problem of "working poverty."

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Kaye, Kelleen
202-401-6634

PIC ID: 6360

PERFORMER: University of North Carolina at Chapel Hill, School of Public Health
Chapel Hill NC

Fixing to Change: A Best Practices Assessment of One-Stop Job Centers Working With Welfare Recipients

This study was undertaken in an effort to assess the impacts of recent policy, organizational, and technology changes on the delivery of employment services to welfare recipients. The study examines five of the most developed and promising One- Stop Job Centers around the country to find out what makes them work well, and to understand their potential for moving people from welfare to self-sufficiency. This study does not provide a formal evaluation of these model programs, but identifies those approaches and practices that seem to be working well in various locations. The report identified three key factors which tend to contribute to the success of the One-Stop Job Center: the degree of integration of services, locating welfare and employment services in the same place, and individualized attention to clients. The centers experienced common problems in such areas as quality and design of data systems as well as such common challenges in reaching the welfare population as substance abuse mental illness. Welfare-to-work programs tended to place a their clients in a fairly limited set of typical occupations, including: certified nurse assistant, clerical support, light manufacturing, sorting and packaging, retail trade, and self employment. Based on limited data that varies from site to site, the employment and wage outcomes reported for a sample of welfare clients referred to a One-Stop center during a given 12-month period hovers between 40 and 50 percent, with wages typically averaging between $5.50 and $6.50 an hour. These jobs were clearly dominated by entry-level work and not sufficient to support a family without continued public assistance.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Kaye, Kelleen
202-401-6634

PIC ID: 7152

PERFORMER: University of Washington
Seattle, WA

Get Organized: A Guide to Preventing Teen Pregnancy

This practical tool kit for families which want to prevent teen pregnancy is divided into three volumes: Focusing on Kids, Involving the Key Players, and Making It Happen. Volume One, Focusing on Kids, involves the following topics: promising approaches to preventing teen pregnancy, tailoring pregnancy prevention to stages of adolescent development, developing pregnancy prevention programs for girls and young women, involving teen boys and young men in teen pregnancy prevention, and involving youth in teen pregnancy prevention programs. Volume Two, Involving the Key Players, covers the following topics: involving parents and other adults, involving the faith community, involving schools, and involving healthcare professionals. Volume Three, Making it Happen, covers the following topics: getting your community involved in a teen pregnancy prevention project, tailoring a program to your community through needs assessment, planning and carrying out a teen pregnancy prevention project, raising funds for teen pregnancy prevention, working with the media to promote teen pregnancy prevention, building evaluation into your work, and moving forward in the face of conflict.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Chessen, Sonia
202-690-8471

PIC ID: 6725.1

PERFORMER: Urban Institute
Washington, DC

Getting off the Ground: Early Implementation Findings about Child Support Enforcement, Head Start, and Child Care Collaboration Demonstrations

The purpose of this report is to provide early findings on the implementation of five State-initiated demonstrations designed to explore collaborations between child support enforcement, Head Start, and child care programs. The early findings indicate that the demonstration projects are making progress in meeting their goals. Also, the partner's agencies have gained an enhanced understanding and trust, and the knowledge base of Head Start and child care staff about child support services and vice versa, has broadened. The second goal of the project, to increase the access of families to child support services through the cooperation and assistance of child care and Head Start programs is being realized. These demonstration grants have increased the willingness and ability of Head start and child care staffs to collaborate with child support agencies. Some agreement has also been reached toward the third goal of the project--to increase child support staff's understanding about the importance of father's nonfinancial involvement in the lives of their children. An important task remaining for the demonstrations is to find ways that child support staff can assist child care and Head Start staffs in increasing voluntary establishment of paternity and payment of support.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Mellgren, Linda
202-690-6806

PIC ID: 7087

PERFORMER: American Institutes for Research
Washington, DC

Indicators of Welfare Dependence: Annual Report to Congress, October 1998

The Welfare Indicators Act of 1994 requires the Department of Health and Human Services to prepare annual reports to Congress on indicators and predictors of welfare dependence. This Annual Report on Welfare Indicators, October 1998 is the second of these annual reports. Welfare dependence, like poverty, is a continuum, with variations in degree and in duration. The bipartisan Advisory Board on Welfare Indicators proposed the following definition of dependence on welfare: A family is dependent on welfare if more than 50 percent of its total income in a one-year period comes from AFDC/TANF, Food Stamps and/or SSI, and this welfare income is not associated with work activities. Welfare dependence is the proportion of all families who are dependent on welfare. This report includes a number of indicators addressing welfare recipients, dependence, and labor force attachment. Selected findings include the following: In 1994, the more recent year for which SIPP data are available, 5.6 percent of the total population were dependent. This is approximately the same rate as the previous two years; long-term dependence is relatively rare. Only 4 percent of those who were recipients in 1982, or less than 1 percent of the total population, received more than 50 percent of their income from AFDC and Food Stamps in 9 or 20 years over the next decade; in 1994, 46 percent of AFDC recipients, 38 percent of SSI recipients and 57 percent of Food Stamp recipients were in families with at least one person in the labor force; and individuals who receive AFDC or Food Stamps as children are more likely to receive benefits as adults.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Isaacs, Julia
202-690-6805

PIC ID: 7281.2

PERFORMER: Office of the Assistant Secretary for Planning and Evaluation, Office of Health Policy
Washington, DC

Positive Youth Development in the United States: Research Findings on Evaluations of Positive Youth Development Programs

The past 30 years have seen widespread proliferation of prevention and positive youth development programs. During this time, prevention programs have been the subject of much evaluative study. More recently, the field has witnessed a greater focus on evaluation of programs emphasizing positive youth development. Interest in positive youth development has grown as a result of studies that show the same individual, family, school and community factors often predict both positive and negative outcomes for youth. Such factors as developing strong bonds with healthy adults and maintaining regular involvement in positive activities not only create a positive developmental pathway, but can prevent the occurrence of problems. While encouraging, these findings highlight the need for systematic review across programs to further their general acceptance by the field. Accordingly, the goals of this study were to: (1) research and establish both theoretical and empirical definitions of positive youth development and related concepts; (2) document and describe common denominators between risk and protective factors implicated in youth problem behavior; (3) identify and summarize the results of evaluations of positive youth development interventions; and (4) identify elements contributing to both the success and lack of success in positive youth development programs and program evaluations, as well as potential improvements in evaluation approaches.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Chessen, Sonia
202-690-8471

PIC ID: 6878

PERFORMER: University of Washington, Social Development Research Group
Seattle, WA

Post-Exit Earnings and Benefit Receipt Among Those Who Left AFDC in Wisconsin

From July 1995 to July 1996, single-parent Aid to Families with Dependent Children (AFDC) caseloads in Wisconsin declined sharply, by 23 percent. This is the third and final report in a series that explores the characteristics of those mother- headed families who left AFDC after July 1995 ("leavers"), compared to those who remained ("stayers"), and examines how they fared during the 15 months after they left the Wisconsin AFDC program. Specifically, this study asks: (1) What proportion of leavers returned to AFDC, and what characteristics are most closely associated with that return? (2) Did AFDC leavers and their families have incomes greater than (a) the maximum benefits they would have received under AFDC or (b) their incomes immediately before leaving AFDC? (3) Did leavers and their families escape poverty after leaving AFDC? (4) How much did leavers use other public assistance programs, and what household characteristics most affected the likelihood that they would do so? (5) To what extent did leavers work and earn after they left AFDC, and how did these trends compare to the work and earning patterns of the stayers? (6) Did the earnings of the leavers grow over time, and, if so, to what extent? (7) What family and economic characteristics among leavers were most closely related to the probability of working at all, and of obtaining relatively high earnings? and (8) What kinds of jobs did leavers find, and which jobs seemed to offer the highest wages?

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Hauan, Susan
202-690-8698

PIC ID: 6727

PERFORMER: Institute for Research on Poverty
Madison WI

State Child Access and Visitation Programs: A Preliminary Report for Fiscal Year 1997 Funding

This report presents preliminary findings for 131 local projects in 28 States and two Territorities receiving funding for Child Access and Visitation Grants under the Personal Responsibility and Work Opportunity Reconciliation Act of 1996. Nearly 20,000 individuals were served during the first year of this new grant program, and this figure is expected to rise, significantly, when all States report. Wide discretion is permitted in States' determination of the activities to fund at the local level. Most States and their local projects report providing a mix of services. There are services provided with respect to urban, suburban, and rural locations and administration by state and county agencies, courts, and non-profit organizations. There is also a balance regarding the racial and ethnic mix and marital status--divorced, separated, never-married-- of the population served. Most individuals received parenting education, assistance in developing parenting plans, and mediation services, and the majority of individuals referred completed their program activities.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Mellgren, Linda
202-690-6806

PIC ID: 7337

PERFORMER: American Institutes for Research
Washington, DC

State Financing of Child Support Enforcement Programs: Final Report

The primary goal of the Child Support Enforcement (CSE) program is to ensure that children are supported financially by both parents. This program is a shared undertaking involving Federal, State, and local efforts. The subject of this report is how states finance their share of the cost of program activities. The following questions are addressed: (1) what are the various sources of funding for the State and local share of Title IV-D expenditures, and what share of expenditures does each source represent? (2) how is the State share of retained Temporary Assistance for Needy Families (TANF) program collections allocated at the State and local level? (3) how are Federal incentive payments allocated at the State and local level? Information was collected through telephone contacts with State IV-D Directors and/or IV-D fiscal staff in every state. The results show that: (1) most programs utilize at least three different funding sources to finance the State and local share of CSE expenditures; (2) State and local CSE financing structures are diverse and their funding sources are mixed in a variety of ways.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Mellgren, Linda
202-690-6806

PIC ID: 7249

PERFORMER: The Lewin Group
Falls Church, VA

Synthesis of Research on Family Preservation and Family Reunification Programs

This report examines research about the outcomes of family preservation and family reunification programs, about relationships between service characteristics and outcomes, and the response of subgroups of clients to services. The report finds that: (1) little evidence exists to show that these programs have their intended effects; (2) problems with study construction and sampling issues contribute to a general lack of information about the effects of these programs in preserving or reunifying families, on preventing maltreatment, and on foster care placements; (3) in general, a review of research suggests that family preservation programs have very modest effects on family and child functioning; (4) evaluations of family reunifications are in a nascent stage, and require further elaboration of goals and expected outcomes of the programs; (5) evaluations must use the most rigorous methods whenever possible (i.e., randomized experimental designs) because early uncontrolled studies yielding misleading findings; and (6) more research must be done on the differential impact of these programs on various subgroupings of families. Furthermore, the report finds that outcomes other than placement should be used to detect potential benefits of these programs, and that more attention should be placed on contextual factors affecting outcomes, including community characteristics and the availability of community services. See also PIC ID Nos. 5337 and 5337.2. (Interim report 76 pages.)

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Stagner, Matthew
202-690-5653

PIC ID: 5337.1

PERFORMER: Westat, Inc.
Rockville, MD

Program Systems

Online Registry of State Health Data Policy Initiatives-Update

In 1996, HHS contracted The Lewin Group to develop a registry of projects that integrates health information systems at the state level. The registry is located on the World Wide Web at http://aspe.hhs.gov/statereg/index.htm. The home page compiles, abstracts, and indexes summary information on data integration projects for all 50 states and the District of Columbia. The purpose of the registry is twofold. First, the registry gives Federal policymakers a central source for researching the types of integration activities being pursued by individual states. Second, the registry, facilitates communication among states regarding data integration activities and related data policy activities. The project: (1) provides a resource for state and local policymakers as they seek to identify others who have pursued information integration activities; (2) facilitates information sharing and collaboration across states; and (3) assists Federal policymakers in monitoring, assessing, and supporting state-level integration activities. Relevant state integration projects were identified through: (1) contacts with state officials responsible for hospital discharge databases, vital statistics, Medicaid data, and any other major information system or data-related offices; (2) conferences on state data integration activities; (3) grantee information related to specific funds which target information activity; (4) state health department web sites; and (5) recommendations from people interviewed. The project was completed in 1997. A second contract resulted in two updates to the materials for the website. The most recent update should be posted on the site by March 1999. The database is administered by the Office of the Assistant Secretary for Planning and Evaluation. (Final report is a web site: http://aspe.hhs.gov/statereg/index.htm.)

AGENCY SPONSOR: Office of Program Systems

FEDERAL CONTACT: Hitchcock, Dale
202-690-5882

PIC ID: 6178

PERFORMER: The Lewin Group
Fairfax, VA

Practical Lessons: The 1998 National Symposium on Homelessness Research

This report compiles a review of more than a decade of research and expert consensus on solutions to homelessness in the United States. This manual, published by the Departments of Health and Human Services and Housing and Urban Development, is for those concerned with and working to solve the problem of how to provide services to homeless persons most effectively. It is a compilation of research performed which stresses the importance of street-based outreach services to homeless individuals, intensive case management to help homeless persons gain access to treatment and maintain residential placement and techniques for building the local conditions that are needed to end homelessness. The report documents successes for working with homeless persons and acknowledges that homelessnesss is not a simple issue and that dimensions of the economy, supplies of affordable housing, disability, family support and individual characteristics all interact to affect who becomes homeless. The complexity of cause must be accommodated when researching and implementing solutions. This HUD/HHS collaborative project provides a broad and critical review of the nature of homelessness and characteristics of the homeless population; the special needs of homeless persons with disabilities; critical support services and other assistance homeless people need to become more self-sufficient; and new approaches to the problem.

AGENCY SPONSOR: Office of Program Systems

FEDERAL CONTACT: O'Connell, Mary Ellen
202-260-0391

PIC ID: 6817

PERFORMER: Abt Associates, Inc.
Cambridge, MA

Strategies for Obtaining Public Health Infrastructure Data at Federal, State, and Local Levels: Final Report

This project enabled the development of a strategy for obtaining comprehensive baseline and trend data on the public health infrastructure at the national, state, and local levels. The strategy, developed through an intergovernmental partnership, builds on data already being collected. Its purpose is to characterize the capacity and functioning of the full range of federal, State, and local government agencies responsible for carrying out essential public health functions, such as those related to substance abuse, mental health, and environmental health. Furthermore, data needs are also considered. These include those relating to: (1) the provision of public health services; (2) providers of public health services; (3) expenditures on such services; (4) revenue sources and uses; and (5) the extent to which population-based public health services cross-subsidize personal health care services, and vice versa. This kind of information in essential in assessing the impact of rapid changes in the health care system on the public health infrastructure, and will serve as a comprehensive basis for health services research in public health. Project activities were guided by a steering group consisting of 15 members, including representatives of federal, State, and local agencies. In addition, the project: (1) assessed the need for and uses of public health infrastructure data by various parties; (2) identified and evaluated current and prior data sources; (3) considered typologies, definitions, and measurement concepts; (4) and developed alternate approaches for obtaining public health infrastructure data that are scientifically sound, feasible, and cost-effective. The project built on work that has already been accomplished in developing consensus definitions for essential public health services, evaluating public health performance, and obtaining information on public health expenditures. The project resulted in a final report and three appendices.

AGENCY SPONSOR: Office of Program Systems

FEDERAL CONTACT: Scanlon, James
202-690-7100

PIC ID: 6179

PERFORMER: The Lewin Group
Fairfax, VA

In-Progress Evaluations

Disability, Aging and Long-Term Care Policy

A Primer for States and Consumers on Medicaid Home and Community-Based Services

Medicaid, the principal source of financing for long-term care services, has frequently been said to have an "institutional bias," because State spending on nursing homes and institutions outweighs spending on home and community-based supports by a ratio of approximately 80 to 20. Many States have, however, demonstrated that it is possible to work within a Medicaid framework to expand home and community-based services, (HCBS) providing consumers with greater choice and control. Decreased dependence on unnecessary institutional long-term care and the expansion of consumer responsive home and community-based long-term care options are important policies of both the White House and the Secretary for the Department of Health and Human Services. To address this priority, the Office of the Assistant Secretary for Planning and Evaluation (ASPE) proposes to develop a "primer" on existing long-term care options in Medicaid that promote consumer choices in long-term care. The primer will be an important and useful development tool for State Medicaid and aging policy and program staff, consumers and their representatives, and providers interested in the expansion of choices in long-term care, including the promotion of home and community-based options.

AGENCY SPONSOR: Office of Disability, Aging, and Long-Term Care Policy

FEDERAL CONTACT: Kennedy, Gavin
202-690-6443

PIC ID: 7162

PERFORMER: George Washington University Medical Center, Center for Health
Outcomes Improvement Research, Washington, DC

EXPECTED DATE OF COMPLETION: 02/20/2000

A Study of Home Health Practice Variations Study

Medicare home health has been the subject of considerable research, but the actual practice of home health care has not been extensively examined. What takes place during a visit and between visits as "actual practice" has never been measured. Furthermore, the extent to which various parties participate in the decision making process, is also unknown. Such information is needed to improve understanding about actual practice and explain its variations. This study will analyze variations in home health care services, focusing on patient characteristics, provider characteristics, agency characteristics and market characteristics. Primary data will be collected at the patient and agency levels. Data from this study and the Health Care Financing Administration's (HCFA) Outcomes of Home Care Study will be used to assess the relationships between the process of home health care and its outcomes and resource use.

AGENCY SPONSOR: Office of Disability, Aging, and Long-Term Care Policy

FEDERAL CONTACT: Katz, Ruth
202-690-6613

PIC ID: 6168

PERFORMER: Center for Health Policy Research
Denver, CO

EXPECTED DATE OF COMPLETION: 12/20/2000

Analysis of Patterns of Post-Acute and Chronic Care Services Use Among Disabled and Non- Disabled Medicare Beneficiaries: 1989-1994

This study uses the 1989 and 1994 National Long-Term Care Surveys to analyze factors that predicted growth in Medicare post-acute (i.e., home health and skilled nursing facility) benefits from the late 1980s through the mid-1990s.

AGENCY SPONSOR: Office of Disability, Aging, and Long-Term Care Policy

FEDERAL CONTACT: Doty, Pamela
202-690-6613

PIC ID: 6768

PERFORMER: Medstat Group
Cambridge, MA

EXPECTED DATE OF COMPLETION: 09/30/2000

Analysis of the Disability Supplement to the National Health Interview Survey

The disability supplement to the National Health Interview Survey (NHIS-D) is the first comprehensive survey on disability in the United States. The survey is unique in that it focuses on several populations of persons with disabilities who are generally omitted or under-represented in national survey efforts: children, persons with mental retardation and other developmental disabilities and the working-age population. The goal of this project is to conduct a series of analyses and produce both short- term products and final reports that will inform ongoing Assistant Secretary for Planning and Evaluation (ASPE) departmental and administrative research and policy initiatives. The analyses will address a specific set of questions in four topical areas using the NHIS-D: (1) welfare receipt and disability (including chronic illness); (2) disability and chronic illness among low income populations; (3) childhood disability and chronic illness; and (4) employment and disability.

AGENCY SPONSOR: Office of Disability, Aging, and Long-Term Care Policy

FEDERAL CONTACT: Marton, William
202-690-6613

PIC ID: 7153

PERFORMER: Urban Institute
Washington, DC

EXPECTED DATE OF COMPLETION: 03/27/2000

Assessment of Home Care Benefits Used by Holders of Private Long Term Care

This study will examine formal and informal home and community-based long-term care (LTC) services use among private insurance policy holders "in claim" (i.e., those who are receiving insurance benefits). It will compare patterns of formal and informal services use among these insurance claimants with those of a nationally representative sample (from the 1994 National Long-Term Care Survey) of disabled elders living in the community. Statistical processes will be employed to match claimants with particular characteristics (e.g., age, marital status, disability level) to elders in the national sample. The purpose of the comparison will be to measure the effects of private long-term care insurance on access to formal home care services and to determine whether or to what extent insurance-financed formal services supplement or substitute for informal family care. The study will also examine the interaction between insurance financed home care and the use of Medicare home health services.

AGENCY SPONSOR: Office of Disability, Aging, and Long-Term Care Policy

FEDERAL CONTACT: Doty, Pamela
202-690-6613

PIC ID: 6399

PERFORMER: Lifeplans
Waltham MA

EXPECTED DATE OF COMPLETION: 03/20/2000

Characteristics of Nursing Home Residents

Caring for persons with disabilities in the least restrictive setting is a major long-term policy objective. It is important to identify nursing home residents who could be discharged to the community if appropriate home and community-based services were available. This project will analyze data from the Minimum Data Set (MDS). The MDS consists of assessments which have been conducted on all nursing home residents in selected States as part of a HCFA demonstration (and starting the summer of 1998, the data will be collected in all 50 States). Using this new data set will also more information about the medical conditions, functional needs, and specific services used by nursing home residents than was possible with previous data sets. It will also be possible to study important subpopulations, especially the nonelderly. the policy implications of the findings will be assessed.

AGENCY SPONSOR: Office of Disability, Aging, and Long-Term Care Policy

FEDERAL CONTACT: Drabek, John, Ph.D.
202-690-6613

PIC ID: 6275

PERFORMER: University of Michigan
Ann Arbor MI

EXPECTED DATE OF COMPLETION: 09/30/2000

Development and Validation of a Performance Measure Set for the Evaluation of Medicaid Services Rendered to People with Developmental Disabilities

This project is to select and validate a performance measure set that will be used to evaluate the quality and appropriateness of Medicaid services rendered to people with developmental disabilities. It is expected that the measure set developed will be useful within HCFA's regulatory quality monitoring programs and to inform quality improvement activities. The measure set will also be available to provide information to consumers, to provide information on system wide strengths and weaknesses, and to provide information to payers of health care, including HCFA, States and private payment sources, for use in evaluating the quality and value of services. The project will first recommend and then alpha test a performance measure set to determine its utility and feasibility for use in Intermediate Care Facilities for the Mentally Retarded (ICF/MR). Effort will be made to assess information currently collected by States to determine how such information can be used as performance measures.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Couchoud, Elizabeth
410-786-6722

PIC ID: 7391

PERFORMER: Research Triangle Institute
Research Triangle Park, NC

EXPECTED DATE OF COMPLETION: 09/29/2002

Evaluation of Practice in Care (EPIC)

From 1989 to 1992, there was a 210 percent increase in Medicare expenditures for home health services. This increase in utilization has generated policy interest in measures to control expenditures without compromising quality. Medicare home health has been the subject of considerable research, but the actual practice of home health care has not been extensively examined. This study will: (1) analyze "episodes" of care under the Medicare home health benefit, (2) assess the actual practice of care, (3) determine the extent to which there is variation in practice between acute and long-term care patients, and (4) uncover the factors accounting for that variation. The study will also examine decision-making processes between patients, providers and physicians. The events that take place during a visit and between visits as "actual practice" have never been measured. Furthermore, the function of decision-making by various parties has not been observed in "actual practice". This effort to understand issues surrounding regional and practice variations of home health care delivery will aid the Department of Health and Human Services and the industry in combating fraud and abuse, as well as contribute valuable data to a future prospective payment system.

AGENCY SPONSOR: Office of Disability, Aging, and Long-Term Care Policy

FEDERAL CONTACT: Katz, Ruth
202-690-6613

PIC ID: 5888

PERFORMER: Center for Health Policy Research
Denver, CO

EXPECTED DATE OF COMPLETION: 06/30/2000

Evaluation of the District of Columbia's 1115 Waiver for Children with Special Health Care Needs

This project, co-sponsored by ASPE and HCFA's Office of Research and Demonstrations (ORD) is an evaluation of the District of Columbia's 1115 waiver demonstration. The District's waiver is the first approved demonstration to integrate acute and long-term care services for SSI eligible children with disabilities in a single capitated payment system. The study analyzed enrollment data and documented the experiences of the District, the health plan, providers, and children and their families. The study will be used to inform both State and Federal policy makers who increasingly regard managed care as a means of containing growing health care expenditures. The first report is now available on the HHS website: http://aspe/hhs.gov/daltcp/reports/dc-yr1 es.htm.

AGENCY SPONSOR: Office of Disability, Aging, and Long-Term Care Policy

FEDERAL CONTACT: Kennedy, Gavin
202-690-6443

PIC ID: 7361

PERFORMER: Abt Associates, Inc.
Cambridge, MA

EXPECTED DATE OF COMPLETION: 09/30/2000

Evaluation of the Oregon Medicaid Reform Demonstration

The disability supplement to the existing Health Care Financing Administration (HCFA) evaluation of the Oregon Medicaid Reform Demonstration attempts to add a disability focus to the Statewide evaluation. This supplement will focus on the experiences of disabled children and adults (physically disabled, mentally retarded, or developmentally disabled) who are enrolled in the Oregon Health Demonstration. The disability supplement will examine cost and utilization data, and will link this data to functional data collected by State agencies and managed care plans. In addition, the supplement will conduct a survey of consumers and providers to examine issues of satisfaction, access, quality, health status and functioning. See PIC ID 6166 and the 6289 series.

AGENCY SPONSOR: Office of Disability, Aging, and Long-Term Care Policy

FEDERAL CONTACT: McKay, Hunter
202-690-6613

PIC ID: 6166.1

PERFORMER: Health Economics Research, Inc.
Waltham, MA

EXPECTED DATE OF COMPLETION: 12/31/2000

Long Term Care Microsimulation Model

The Long-Term Care Financing Model is a resource which has been extensively used by ASPE to project future long- term care utilization and expenditures and simulate various long term care policy options. These include expansions of public financing, such as those proposed during health care reform, as well as changes to Medicaid and Medicare. The model has also been used extensively to study private sector policy options, such as the impact of further growth on private long-term care insurance and the impacts of changing trends in disability rates on long-term care use and expenditures. Recent data on disability rates, nursing home use, and home care use will be used to update existing portions of the model. In addition, the model will be expanded to include acute care use, thereby increasing the Assistant Secretary for Planning and Evaluation's (ASPE's) ability to simulate a wide range of policy options. ASPE will use this computer model for projections and policy simulation and a series of policy simulations from the revised model will be presented in reports. In addition to its previous long-term care policy uses, the revised model will enable ASPE to address acute care issues, such as the combined burden of acute and long-term care spending on the elderly. Since the model simulates the income and assets of the population, including pension and Social Security payments, the model will also be used to study other aging-related issues, such as the impact of changes in employer-sponsored health insurance for retirees.

AGENCY SPONSOR: Office of Disability, Aging, and Long-Term Care Policy

FEDERAL CONTACT: Drabek, John, Ph.D.
202-690-6613

PIC ID: 7143

PERFORMER: The Lewin Group
Fairfax, VA

EXPECTED DATE OF COMPLETION: 09/30/2000

Longitudinal Study of Welfare Reform and Its Implications for Persons with Disabilities

This project will explore how welfare reform affects the well-being of persons with disabilities. Relevant questions to be addressed in this study include: How will welfare reform affect the well-being of adult TANF recipients with disabilities? What types of accommodations are being made to increase the work capacity of individuals with disabilities? Are persons with disabilities receiving appropriate job training that would enable them to move into the workforce? How will the well- being of children or adults with disabilities be affected if their primary caregiver has to work? How do families that contain persons with disabilities adapt to the new welfare environment? What types of changes in support systems occur to maintain the medical and other care needs of dependents with disabilities? What role do programs for persons with disabilities, such as early intervention programs and Supplemental Security Income (SSI), play following welfare reform?

AGENCY SPONSOR: Office of Disability, Aging, and Long-Term Care Policy

FEDERAL CONTACT: Marton, William
202-690-6613

PIC ID: 7362

PERFORMER: Johns Hopkins University
Baltimore, MD

EXPECTED DATE OF COMPLETION: 09/30/2000

Managed Delivery Systems for Medicare Beneficiaries with Disabilities and Chronic Illnesses

This project will study the experiences of elderly Medicare beneficiaries with disabilities and chronic illnesses in a managed delivery system (MDS) at four separate sites. An MDS is broadly defined as a health care system that integrates the financing and/or delivery of primary, acute and long-term care of persons for the purpose of controlling costs and improving access to, and coordination of, services across a continuum of providers. The specific goals of the study are to: (1) foster a better understanding of the unique characteristics and health/long-term care needs of elderly persons with disabilities and chronic illnesses among health plan administrators, providers and policymakers; (2) assess how managed care delivery systems meet the needs of this population and the factors that promote or impede success; and (3) describe the health care experiences of disabled elderly Medicare beneficiaries in MDS.

AGENCY SPONSOR: Office of Disability, Aging, and Long-Term Care Policy

FEDERAL CONTACT: Harvell, Jennie
202-690-6613

PIC ID: 6391

PERFORMER: Mathematica Policy Research, Inc.
Plainsboro, NJ

EXPECTED DATE OF COMPLETION: 05/30/2001

Medicare Home Health Practice Variations

The main goal of this study is to examine how patient, provider, agency and market/regulatory forces relate to variations in Medicare home health care practices and outcomes. Three key questions form the basis of the study: (1) What is the actual practice of home health care in terms of amount, type and decision-making? (2) How are decisions about care made in light of the Health Care Financing Administration's (HCFA) Medicare home health care coverage rules? and (3) What elements of practice are associated with long lengths of stay in the home health benefit? The study will use a range of quantitative and qualitative methods to address these questions, including longitudinal data collection on samples of home health agencies and home health patients at those agencies, focus groups, case studies and analyses of secondary data.

AGENCY SPONSOR: Office of Disability, Aging, and Long-Term Care Policy

FEDERAL CONTACT: Doty, Pamela
202-690-6613

PIC ID: 6720

PERFORMER: Center for Health Policy Research
Denver, CO

EXPECTED DATE OF COMPLETION: 03/31/2000

Medicare Post-Acute Care: Quality Measurement

This project will specify performance measures that can be used to determine the cost-effectiveness of post-acute care (PAC) services. The specific measures and data elements will apply to patient conditions that are prevalent within and across PAC settings. In addition, this project will identify the data collection methods that could be used with respect to these elements. Finally, this project will identify issues that need to be considered in applying these measures, including whether there is the need to engage in validity and reliability testing, and, if so, how.

AGENCY SPONSOR: Office of Disability, Aging, and Long-Term Care Policy

FEDERAL CONTACT: Harvell, Jennie
202-690-6613

PIC ID: 7363

PERFORMER: Urban Institute
Washington, DC

EXPECTED DATE OF COMPLETION: 12/31/2000

Monitoring the Health Outcomes for Disabled Medicare Beneficiaries

The Balanced Budget Act (BBA) of 1997 mandated major changes in home health payment requiring the implementation of a Prospective Payment System (PPS) by October 1999 (later delayed until October 2000) and an Interim Payment System (IPS) prior to the implementation of PPS. It also contained changes in eligibility and coverage for home health services. These changes, while intended to reduce Medicare home health costs. run the risk of reducing beneficiaries' access to appropriate care and adversely affecting health outcomes, especially for beneficiaries needing the most care. Disabled Medicare beneficiaries are most vulnerable. The purpose of this project is to study the impact of recent payment policy changes on disabled Medicare beneficiaries' satisfaction and quality of life with a view toward formulating inferences that will inform national home health care policy for the disabled. The study will build on a research project recently funded by the Home Care Research Initiative of The Robert Wood Johnson Foundation that examines the direct and indirect effects of the BBA changes. The main focus is to examine BBA impacts on Medicare beneficiaries' access to care, costs, satisfaction, and quality of care.

AGENCY SPONSOR: Office of Disability, Aging, and Long-Term Care Policy

FEDERAL CONTACT: Doty, Pamela
202-690-6613

PIC ID: 7364

PERFORMER: Laguna Research Associates
San Francisco CA

EXPECTED DATE OF COMPLETION: 09/30/2001

Outcomes and Costs Associated with Medicare Post-Acute Services in Skilled Nursing Facilities, Rehabilitation Hospitals/Units, and Home Health Settings

This project will study the cost-effectiveness of Medicare post-acute care services for Medicare beneficiaries with certain conditions, within and across post-acute care settings and over episodes of care. The study will examine the: (1) demographic and health-related characteristics of Medicare beneficiaries who use post-acute services following a hospital stay to examine how much overlap there is in the patient populations treated by each provider type and across provider types; (2) patterns of service use and costs associated with the treatment of similar patients in each setting and across episodes of care; (3) outcomes for similar Medicare beneficiaries by each post-acute provider type and across episodes including those in which multiple providers are used; (4) relationship between outcomes for similar patients and differences in the mix and intensity of services provided, and level of reimbursement across post-acute care providers and episodes of care; and (5) core measures that are most useful to incorporate into on-going reporting requirements to monitor outcomes in each post-acute care setting and across episodes of care.

AGENCY SPONSOR: Office of Disability, Aging, and Long-Term Care Policy

FEDERAL CONTACT: Harvell, Jennie
202-690-6613

PIC ID: 6836

PERFORMER: Mathematica Policy Research, Inc.
Washington, DC

EXPECTED DATE OF COMPLETION: 08/31/2003

Personal Assistance Services "Cash and Counseling" Demonstration/Evaluation

This study will employ a classical experimental research design (i.e. random assignment of participants to treatment and control groups) in order to test the effects of "cashing out" Medicaid-funded personal assistance services for the disabled. Arkansas and New York are expected to participate in the demonstration, with an option to expand to include New Jersey and Florida. Control group members will receive "traditional" benefits in the form of case-managed home and community- based services where payments for services are made to vendors. Treatment group members will receive a monthly cash payment in an amount roughly equal to the cash value of the services that they would have received under the traditional program. It is hypothesized that cash payments will foster greater client autonomy and that, as a result, consumer satisfaction (particularly among disabled persons under age 65) will be greater. It is also hypothesized that States will save Medicaid monies (mostly in administrative expenses) from cashing out benefits.

AGENCY SPONSOR: Office of Disability, Aging, and Long-Term Care Policy

FEDERAL CONTACT: Doty, Pamela
202-690-6613

PIC ID: 6161

PERFORMER: University of Maryland, Center on Aging
College Park MD

EXPECTED DATE OF COMPLETION: 01/20/2001

Private Payers Serving Disabled Individuals and Research Synthesis on Managed Care for Persons with Disabilities

This project serves two major purposes: (1) examine the experiences of disabled persons in managed care plans sponsored by selected large employers, and (2) synthesize the results of all components of the Office of the Assistant Secretary for Planning and Evaluation (ASPE) research plans on managed care and disability and other relevant research in order to analyze their implications for policy development. The employer-based portion of the project will: (1) develop a methodology for identifying individuals with disabilities from the health care databases maintained by several large employers and health insurers; and (2) track the impact of managed care enrollment on disabled participants and their access to appropriate services, service utilization patterns, health care expenditures and quality of care. The policy synthesis will use the information gathered in the employer-based part of the project in conjunction with Medicaid evaluations, Department of Health and Human Services (HHS) research and other relevant information in order to draw lessons for policy research on several issues. These issues include: (1) the performance of managed care in serving people with disabilities compared to fee- for-service plans; (2) how, and to what extent, managed care plans can provide comprehensive services to this population in a financially viable manner; (3) the development of risk adjustment and risk sharing in order to provide incentives to clinically appropriate and cost-effective care; and (4) the policies and practices most likely to contribute to an appropriate balance between clinical and financial success.

AGENCY SPONSOR: Office of Disability, Aging, and Long-Term Care Policy

FEDERAL CONTACT: Drabek, John, Ph.D.
202-690-6613

PIC ID: 6398

PERFORMER: Medstat Group
Cambridge, MA

EXPECTED DATE OF COMPLETION: 09/28/2000

Research on Employment Supports for People with Disabilities

The goal of this contract is to provide information to help improve the employment rate of adults with disabilities. This includes: (1) gathering descriptive data about public and private sector employment programs, (2) examining successful employment supports, and (3) investigating factors affecting the ability to work. The products from this study will benefit the disabled and those interested in improving employment opportunities for people with significant disabilities.

AGENCY SPONSOR: Office of Disability, Aging, and Long-Term Care Policy

FEDERAL CONTACT: Brown, Floyd
202-690-6613

PIC ID: 4917.2

PERFORMER: The Lewin Group
Fairfax, VA

EXPECTED DATE OF COMPLETION: 04/20/2000

State Activities in Serving Persons with Disabilities in Managed Care Arrangements

The goal of this project is to obtain four papers from the National Academy for State Health Policy (NASHP) and link them to the DALTCP's managed care and disability website. Three of these papers have been previously prepared by NASHP, and require updating and reformatting. The fourth paper, analyzing trends in the State Medicaid managed care programs related to disability, will require analysis of previously collected State level data. DALTCP intends, through this project, to build a collaborative relationship with NASHP as a technical assistance and case study resource for the managed care and disability research agenda within the Office of the Assistant Secretary for Planning and Evaluation. The specific objectives of this task order are as follows: (1) to re-analyze current managed care work and to glean specific information about disability policy and practice in the areas of elderly, dual eligibles, emerging practices/policies, and NASHP's State survey; and (2) to develop the appropriate mechanisms to link the NASHP web page to ASPE's web page.

AGENCY SPONSOR: Office of Disability, Aging, and Long-Term Care Policy

FEDERAL CONTACT: McKay, Hunter
202-690-6613

PIC ID: 7366

PERFORMER: George Washington University
Washington, DC

EXPECTED DATE OF COMPLETION: 09/30/2000

Synthesis and Analysis of Medicare Hospice Benefit

The rapid rise in Medicare hospice expenditures, particularly on behalf of nursing home residents, has drawn the attention of a wide variety of health policymakers and the Office of the Inspector General (OIG). The OIG has advanced recommendations to modify how Medicare and Medicaid will pay for these services. However, a larger study is needed to examine key hospice trends nationally and in selected States. Additional information on the Medicare hospice benefit, including trends in utilization and expenditures, who is covered, and where, will help inform health policymakers as they consider alternative hospice benefit and payment designs. This project will describe trends and issues with the Medicare hospice benefit, particularly with respect to nursing home residents who elect this benefit. Information will be gathered through a review of the literature, discussion with key informants, and an analysis of claims, assessment and provider data. This project will: (1) examine trends in Medicare and Medicaid hospice and non-hospice utilization and expenditures for hospice and other similar beneficiaries; and (2) compare the quality of care for hospice beneficiaries.

AGENCY SPONSOR: Office of Disability, Aging, and Long-Term Care Policy

FEDERAL CONTACT: Harvell, Jennie
202-690-6613

PIC ID: 7154

PERFORMER: Urban Institute
Washington, DC

EXPECTED DATE OF COMPLETION: 01/31/2000

Health Policy

Access and Utilization of New Antidepressant and Antipsychotic Medications

The proposed project involves a collaboration with the National Institute of Mental Health (NIMH). Very little is known about how and why decisions are made regarding insurance coverage for many of the newer antidepressant and antipsychotic medications. The proposed study will provide important insight and knowledge from multiple perspectives (and with regard to multiple programs) concerning the often complex processes related to access, utilization and coverage of newer psychotropic medications. This new knowledge will serve to inform the department in efforts to evaluate existing and proposed policies.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Hennessy, Kevin
202-690-7272

PIC ID: 7193

PERFORMER: The Lewin Group
Fairfax, VA

EXPECTED DATE OF COMPLETION: 09/30/2000

An Inventory of Federal HIV-Related Databases

This project will develop an inventory of major Federally sponsored HIV-related databases. The inventory will describe the relevant databases and review their potential applications for administrative, clinical research, epidemiologic, financing, policymaking, or program administration purposes. It will also identify key research questions that could be addressed by these databases and identify opportunities for cross-agency collaboration in data collection or analysis. The project will produce a final report including an annotated inventory, as well as the relevant database assessments that point to key research issues and opportunities for interagency collaboration and cross-cutting analyses.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Hardy, Leslie
202-690-7858

PIC ID: 7146

PERFORMER: George Washington University Medical Center
Washington, DC

EXPECTED DATE OF COMPLETION: 10/20/1999

Assessing Core Capacity for Infectious Disease Surveillance

This project will assess the capacity of the infectious disease surveillance system in the United States. The purpose is to identify major gaps in infectious disease surveillance preparedness and to develop an investment framework to address the gaps identified. This multi-part study included a comprehensive literature review, interviews with infectious disease experts, two expert panel meetings, and site visits to three public health jurisdictions. The final investment plan will include detailed information on specific investment strategies that will ensure adequate capacity to identify and understand infectious disease threats.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Pernack, Andrea
202-690-6860

PIC ID: 7351

PERFORMER: The Lewin Group
Falls Church, VA

EXPECTED DATE OF COMPLETION: 09/30/2000

Assessment of Approaches to Evaluating Telemedicine Programs and Projects

This project will collect information on current and planned evaluations of telemedicine activities; assess the purpose and methods of such evaluations and the relevance of the resulting or potential findings to federal policy and programs; and develop a conceptual framework for designing such evaluations. Information will be collected through literature searchers, interviews and document review at Federal agencies, and site visits to ongoing telemedicine projects. The purpose of the study is to develop a better understanding of how telemedicine evaluations can be designed to better inform and facilitate Federal program and policy decisions.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Hertz, Tom
202-690-7779

PIC ID: 7340

PERFORMER: The Lewin Group
Falls Church, VA

EXPECTED DATE OF COMPLETION: 03/09/2000

Comparative Analysis of Decliners of Employer-Based Health Insurance

This study will compare health care use of uninsured decliners to uninsured and insured workers. One theory for why certain people decline offered health insurance is that it is not a good deal for them--especially young, single, relatively low wage workers. To test this theory, we will compare health care use for workers who decline employer offered insurance to other uninsured workers and to insured workers using the NHIS and controlling fro age, health status, income and other factors that are related to health care use.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Goodell, Sarah
202-401-0882

PIC ID: 7345

PERFORMER: Urban Institute
Washington, DC

EXPECTED DATE OF COMPLETION: 07/06/2000

Consequences and Cost of Intimate Partner Violence

This project will apply the methodology developed in "The Cost of Domestic Violence to the Health Care System" (PIC ID No. 4528) to prevalence and other data related to violence committed by adult intimate partners. The study will document the incidence of violence against women by intimate partners, estimate economic costs of related injuries and develop preliminary recommendations for reducing incidence and related injuries. It will form the basis for a report to Congress, authorized under the Crime Act. This project will be jointly funded by the Office of the Assistant Secretary for Planning and Evaluation (ASPE) and the Centers for Disease Control and Prevention (CDC). See also PIC 4528.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Howard, Sandra
202-690-7778

PIC ID: 4528.1

PERFORMER: University of CA, San Francisco, Institute for Health and Aging
San Francisco CA

EXPECTED DATE OF COMPLETION: 12/30/1999

Construction of an Integrated Measure of the Burden of Disease

The burden of disease in a population consists of the morbidity and disability experienced by its members, their psychological perception of the adequacy and effectiveness of the care they receive, and resources expended for health maintenance. The essence of medical care is to determine the balance among these components that will most enhance overall health. The objective of the proposed project is to develop and evaluate analytic techniques that will permit: (1) the construction of an integrated measure of the burden of disease based on the explicit assessment of what trade-offs are currently accepted; and (2) identify changes in strategies to optimize the mix.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Hennessy, Kevin
202-690-7272

PIC ID: 7142

PERFORMER: The Lewin Group
Fairfax, VA

EXPECTED DATE OF COMPLETION: 02/28/2000

Consumer Protection in Private Insurance: State Implementation and Enforcement Experience

This project will attempt to assess the major sources of consumer dissatisfaction with health plans, based on the complaints that are filed. It will also assess implementation of two or three selected consumer protections in a few states that have had such protections in place for several years, such as the ER "prudent layperson" standard and direct access to OB/Gyn, and anti-gag provisions. The project would look at how state health and insurance departments, state attorney general offices implement/enforce existing legislation relevant to state consumer protection laws. A task-order contractor would compile and categorize the nature of consumer complaints about health plans from as many sources of complaints as possible. The contractor will also inquire about related issues, such as: how do States handle complaints from consumers in ERISA- regulated plans? Are complaints being used to improve health plan operations?

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Shoenecker, Sarah
202-401-0882

PIC ID: 7344

PERFORMER: The Lewin Group
Falls Church, VA

EXPECTED DATE OF COMPLETION: 09/12/2000

Consumer Protection in Public Health Programs

The Consumer Protection Workgroup of the Secretary's Quality Initiative has been working over the past year to identify ways in which the beneficiaries and participants in all Department programs could be assured protections at least equal to those identified in the Consumer bill of Rights and Responsibilities. This project will look at standards for care that service providers must follow as well as other consumer protection issues as they arise in the Public Health Service programs. Specifically, it will fund an expert workshop and paper that would bring together researchers, state representatives, consumer representatives and others to provide outside expert guidance to the workgoup about the need to modify or strengthen consumer protections in both direct and block grant-funded programs, and provide recommendations for possible program changes. As funds allow, this allocation will also be used to provide seed money for other projects identified by the workgroup.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Fernandez, Bernadette
202-401-8398

PIC ID: 7339

PERFORMER: Health Systems Research, Inc.
Washington, DC

EXPECTED DATE OF COMPLETION: 04/13/2000

Developing a Framework for Domestic Infectious Diseases Surveillance

The purpose of this study is to develop an analytic framework that can be used to help create consensus on core capacities needed at each level of government for effective national infectious diseases surveillance. Emphasis will be placed on several areas including: (1) defining the relative roles of each level of government, and of the public and private sectors; (2) analyzing resource issues with particular attention to sources of funding, and to categorical versus integrated funding streams; (3) translating surveillance activities into meaningful public health responses; (4) evaluating surveillance activities; and (5) identifying training needs. The study will take into account the rapidly changing environment, especially the role of local health departments, and the changing nature of infectious diseases. The work will consist of: (1) collecting and analyzing data and information from the literature and from experts; (2) using this information to develop an initial framework describing what is needed for effective surveillance; and (3) establishing an expert panel which will use the framework as a tool to reach consensus on the minimum core capabilities needed at each level of government, and the relative roles of the public and private sector for more effective national infectious diseases surveillance.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Taplin, Caroline
202-690-7906

PIC ID: 7161

PERFORMER: The Lewin Group
Fairfax, VA

EXPECTED DATE OF COMPLETION: 03/31/2000

Employer Decision Making in Health Care Coverage

Employers, particularly larger employers, face a complex array of decisions in developing a health care benefits package for their employees. This project would use a combination of in-house resources and a task-order contract to put together case studies on employers. It will identify employers taking interesting approaches to issues relevant issues surrounding health benefits, and then choose the case study targets. For example, one purchaser has adopted a multi-year contracting strategy which involves a number of give-backs and set-asides tied to the plans ability to reduce absenteeism and produce productivity. This study would examine this and other similar arrangements for strengths, weaknesses and possible implications for use by the Medicare and Medicaid programs.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Finan, Stephen
202-690-7387

PIC ID: 7338

PERFORMER: Mathematica Policy Research, Inc.
Washington, DC

EXPECTED DATE OF COMPLETION: 12/19/2000

Evaluating the Effects of Direct-to-Consumer Advertising on Consumers

The goal of this project is to improve our understanding of direct-to-consumer (DTC) advertising. The relation of this kind of advertising to aspects of public health will be examined through a survey of selected consumers and the Food and Drug Administration (FDA) Center for Drug Evaluation and Research's (CDER) analysis of that survey. This analysis will yield an initial broad description of some possible associations between DTC advertising and consumer knowledge, attitudes and behaviors. The survey and CDER's descriptive analysis will lay the foundation for the long- term task of determining what effects DTC advertising may have on overall consumer knowledge, attitudes and behaviors concerning prescription drugs and the overall effects of this practice on the public health.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Bruns, Susannah
202-690-7996

PIC ID: 6343

PERFORMER: Market Facts, Inc.
McLean VA

EXPECTED DATE OF COMPLETION: 01/01/1999

Evaluation of Seafood Hazard Analysis Critical Control Point (HACCP) Program

The Seafood Hazard Analysis Critical Control Point (NACCP) Program mandates the application of HACCP principles to the processing of seafood. HACCP is a preventive system of hazard control that can be used by processors to evaluate the kinds of hazards that could affect products, institute appropriate controls to keep the hazards from occurring or minimize their occurrence, and monitor performance of those controls. this program supplants the old FDA seafood inspection system. The effective date of the program is December 1997. In approving FDA's Seafood HACCP final rule, the Department committed to evaluating the program. The proposed project would develop an evaluation program to be implemented sometime after the rule's effective date.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Bush, Laina
202-260-7329

PIC ID: 7343

PERFORMER: Research Triangle Institute
Research Triangle Park, NC

EXPECTED DATE OF COMPLETION: 06/01/2000

Evaluation of the Projects for Assistance in Transition from Homelessness (PATH) Program

The proposed project involves a collaboration with the Substance Abuse and Mental Health Services Administration (SAMHSA) to conduct an evaluation of the Projects for Assistance in Transition from Homelessness (PATH) Program. The objectives of the proposed evaluation are to: (1) assess whether PATH-funded expenditures are consistent with the authorizing legislation; and the adequacy of program controls; (2) develop a typology for better understanding the delivery of local PATH-funded services and assess whether the typology adequately characterizes meaningful differences in process-level variables, such as outreach and engagement activities with clients; (3) provide background information useful in interpreting data collected to meet the Government Performance and Results Act (GPRA) requirements; and to suggest measures that may be used in conjunction with the GPRA mandate; and (4) examine, where possible in site visit programs, existing administrative or client-level data to describe relevant outcomes for a sample (albeit non-representative) of PATH program participants.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Hennessy, Kevin
202-690-7272

PIC ID: 7210

PERFORMER: Westat, Inc.
Rockville, MD

EXPECTED DATE OF COMPLETION: 08/20/2000

EZ/EC Strategies for Addressing Health Issues

This project will review Empowerment Zone and Enterprise Community (EZ/EC) strategic plans and interview key EZ/EC leaders and local and State health officials to determine: the extent to which current EZ/EC plans/benchmark documents feature projects addressing particular public health and health care access issues, including a synopsis of the health components of individual EZ/EC projects; the extent to which local and state public health departments have been or continue to be active participants in local EZ/EC planning and implementation processes, including the reasons why they have or have not been key players in particular EZ/EC processes; and the extent to which the racial health disparities target health conditions that are prevalent in individual EZ/EC neighborhoods.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Greenberg, Barbara
202-401-8279

PIC ID: 7341

PERFORMER: Public Health Foundation
Washington, DC

EXPECTED DATE OF COMPLETION: 09/30/2000

Factors Influencing Effective Dissemination of Prevention Research Findings by DHHS

This project is designed to further our understanding of the mechanisms that affect the movement of health promotion and disease prevention research findings from one stage to the next and the role the Department of Health and Human Services (HHS) plays in each of these stages. by identifying the relevant mechanisms that affect the dissemination process, HHS will be better able to successfully disseminate the research findings which have public health and clinical importance. In addition, HHS has a direct stake in effective dissemination of research findings for purposes of producing improvements in Departmental programs such as Medicare and Medicaid and to improve the quality of life for the people served by programs such as Head Start.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Pernack, Andrea
202-690-6860

PIC ID: 7347

PERFORMER: The Lewin Group
Falls Church, VA

EXPECTED DATE OF COMPLETION: 12/13/2000

Follow-Up to Clustering Co-Occurrence Youth Risky Behaviors

A current project has analyzed data from several major Departmental surveys (the National Longitudinal Study on Adolescent Health, the Youth Risk Behavior Survey, and the National Survey of Adolescent Males), and produced a series of data tables and three Research briefs regarding incidence and prevalence estimates for various clusterings/co-occurrences of risky behaviors among youth, as well as the clustering of risk and "positive" behaviors. This study would seek to conduct further and more detailed analyses on some of the findings emerging from the existing project. These additional analyses would then be presented in a series of working papers that would be disseminated to researchers, policy makers, Federal and State program staff in child and youth areas, and other relevant stakeholders.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Hennessy, Kevin
202-690-7272

PIC ID: 7349

PERFORMER: Urban Institute
Washington, DC

EXPECTED DATE OF COMPLETION: 08/01/2000

Impact of Medicare HMO Enrollment on Health Care Costs in California

The Office of the Assistant Secretary for Planning and Evaluation (OASPE) is supporting a time series study of the relationships between competition in hospital markets and the prices of hospital care, hospital revenues and hospital costs. The project began in the late 1980s and was extended in 1994 to investigate how health maintenance organization (HMO) enrollment affects changes in Medicare payments on behalf of beneficiaries. The project will collect time series data on California Hospitals (cost reports supplemented by a small survey on selective contracting by the hospital) to investigate whether competition continues to depress hospital prices, revenues and costs. In addition, several smaller projects are underway to investigate whether hospital mergers result in increased prices and a series of investigations (individual and county level) to determine if HMO enrollment leads to a decline in Medicare costs when other appropriate variables are held constant. California is particularly important in this study, because it tends to be a trend-setting State.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Greenberg, George
202-690-7794

PIC ID: 6889

PERFORMER: Rand Corporation
Santa Monica, CA

EXPECTED DATE OF COMPLETION: 09/30/2001

Innovative Coverage of Health Promotion, Clinical Preventive Services, and Other Coverage Issues in the Private Sector

Despite the important private sector employers play in shaping the current health care market, the views of this group concerning the provision of a variety of clinical preventive services and what their health plans currently provide have not been adequately described. In addition, the factors which influence their decisions to include or exclude such services have not been characterized. In collaboration with the Office of Disease Prevention and Health Promotion (ODPHP), and the Office of the Assistant Secretary for Planning and Evaluation (ASPE), researchers are forming a partnership with Partnership for Prevention to support the commissioning of a set of expert papers on the clinical preventive service benefits offered by employer-sponsored health plans. These papers are intended to meet two objectives: (1) to characterize the trends and decision processes occurring within the private sector; and (2) to evaluate the impact of government information on this issue in the private sector. As the government is investing its resources in producing and disseminating information designed to encourage the appropriate use of clinical preventive services, it is important to know how its customers in the private sector perceive and use such information.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Taplin, Caroline
202-690-7906

PIC ID: 6347

PERFORMER: Partnership For Prevention
Washington, DC

EXPECTED DATE OF COMPLETION: 11/20/1999

Low-Income and Low-Skilled Worker's Involvement in Non-Standard Employment

A growing proportion of the work force is involved in forms of nonstandard employment such as temporary work, and there is apparently considerable overlap between the nonstandard workforce and at-risk populations such as the low-income and low- skilled and public assistance recipients or ex-recipients. These circumstances have combined to spur a strong policy interest in the implications of nonstandard employment for the well-being of those who enter it. This project was developed to achieve a greater understanding of the circumstances, characteristics and trends of those involved in the alternative workforce who are most at risk of welfare dependency--i.e., current assistance recipients and the low-income and low-skilled in general. It is hoped that insight will be gained into the conditions of the nonstandard work sectors, the experiences of employers hiring welfare clients to fill nonstandard slots, to better understand the employment context for these at-risk populations. The overall aim in doing these descriptive analyses is to answer the question: Are those at risk of welfare dependency who enter nonstandard employment better or worse off than their counterparts in more traditional jobs?

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Landey, Alana
202-401-6636

PIC ID: 7367

PERFORMER: Urban Institute
Washington, DC

EXPECTED DATE OF COMPLETION: 06/08/2001

Medicare Supplement Insurance: Structure, Change & Implications

The purpose of this research project is to determine whether or how the Medicare Supplement Insurance market has changed. Better information about how this market behaves and how it is changing over time can help the Department develop policies that will ensure stable health care financing for the elderly. This project is proposed to develop three research papers: (1) an examination of variation of the Med-supp market among states; (2) the effect of HMO penetration on Med-supp markets; and (3) the demand for prescription drug benefits in the Med-supp market. Collectively, these papers should provide a much better understanding of how this market has been operating, and thereby provide a better understanding of how new Medicare policies might affect it.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Finan, Stephen
202-690-7387

PIC ID: 7348

PERFORMER: Alpha Center
Bethesda, MD

EXPECTED DATE OF COMPLETION: 09/30/2000

Preventing Abusive Intimate Relationships Among Adolescents

The role of abusive relationships in the lives of adolescents is not as well researched or understood as either adult domestic violence or child abuse. A recent study found that 60 percent of young women who had sex before age 15 were involved in coercive sexual relationships. Apart from this study there is little research on coercive, controlling, or abusive relationships among teenagers. A new source of data in this area, the National Longitudinal Study of Adolescent Health (Add Health) has just been made available to the public. This project will examine the issue of abusive relationships among teenagers through a literature review, analysis of available data, identification of data needs, focused discussion groups, a summary of promising approaches to prevention and intervention and recommendations for further research and discussion.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Howard, Sandra
202-690-7778

PIC ID: 6751

PERFORMER: Research Triangle Institute
Research Triangle Park, NC

EXPECTED DATE OF COMPLETION: 01/31/2000

Safety Net Framework Project

The Nation's health care provider safety net consists of: (1) hospitals, (2) primary care facilities, (3) specialized service providers such as family planning clinics, HIV service providers, community mental health centers, drug and alcohol treatment clinics, and (4) individual practitioners. These providers operate under both public and private auspices. As a group they are diverse, with varied funding sources including: (1) Medicaid and Medicare patient revenues and other payments, (2) Federal grant support from multiple sources, (3) other grants, (4) State and local public funding, (5) limited private third party insurance, (6) patient fees (often sliding scale), and (7) private philanthropy. Federal policy affects these providers in several ways. Products from this project will include a series of working papers, a workshop summary and a final "framework" document. The project is intended to result in new ways of shaping the Department's views concerning safety net providers. In particular, the Department plans to have a structure which considers how Federal grant programs, payment policies and other Federal policies affect these providers as they interact among each other at the community level.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Taplin, Caroline
202-690-7906

PIC ID: 7156

PERFORMER: Northwestern University
Evanston IL

EXPECTED DATE OF COMPLETION: 02/28/2000

Safety Net Project: Exploring State Use of Medicaid Disproportionate Share Funds to Enhance Provision of Care to Uninsured

This project will study the cases in which States redirected or changed their use of Medicaid Disproportionate Share Funds (DSF) funding streams to strengthen safety net infrastructure in communities within their States; used DSF to increase the services available to uninsured populations; or provided insurance to previously uninsured individuals through DSF.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Greenberg, George
202-690-7794

PIC ID: 7352

PERFORMER: Urban Institute
Washington, DC

EXPECTED DATE OF COMPLETION: 09/30/2000

State Activity Monitoring Medicaid Managed Care for Children with Special Health Care Needs

The purpose of this project is to investigate how States are monitoring and evaluating the experience of children with special health care needs enrolled in Medicaid Managed care. Research findings will be used to refine the standards HCFA requires States to meet in order to enroll children with special health care needs into capitated Medicaid managed care plans, and to assess States' ability to meet these standards. Policy makers are interested in addressing the issue of whether Medicaid plans and providers are meeting the complex needs of Supplemental Security Income (SSI) children, for example, but the lack of concrete data or information related to the experience of this population in Medicaid managed care hamper their efforts. In response, HCFA has developed interim review criteria that will be applied to all upcoming 1915(b) waiver applications and renewals from States. The criteria establishes requirements regarding definition, identification, tracking, and access to care for children with special health care needs enrolled in capitated managed care arrangements. This study will help HCFA and the States move forward with this important effort by providing critical information about current State activity and insights as to how these criteria can be refined, improved, and operationalized.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Tolbert, Jennifer
202-205-8678

PIC ID: 7350

PERFORMER: George Washington University Medical Center
Washington, DC

EXPECTED DATE OF COMPLETION: 04/30/2000

State Implementation of Immunization Recommendations and Guidance

This project in Phase 1 will conduct case studies in up to five states to learn how states (in public health, Medicaid and Medicare) are working on the immunization goals using the guidance and technical assistance provided by the federal government. This phase will highlight the status quo and understand the extent to which states are planning to incorporate HCFA's guidance into their activities. Phase 2 (FY 2000) the project will be in up to three of the states and will work with these states to take this activity to the next level, such as identifying and implementing appropriate outcome measures for immunization (e.g., vaccine-preventable disease rates). The goal of the project is to evaluate how states use federal guidance toward improving immunization status and further to assist the federal government on continuing to implement this work with states. Both CDC/National Immunization Program and HCFA would be involved in the project.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Nevel, Amy
202-690-7795

PIC ID: 7342

PERFORMER: Research Triangle Institute
Research Triangle Park, NC

EXPECTED DATE OF COMPLETION: 08/12/2000

The Changing Structure of Health Insurance Markets

This project will result in two research papers evaluating the following: (1) insurance market changes relating specifically to State laws complying with the Health Insurance Portability and Accountability Act of 1996, and (2) the relationship between health insurance market structure and health insurance coverage of the population. This study builds on an ongoing effort funded by the Robert Wood Johnson Foundation to compile an expanded and updated insurer database and to conduct several basic analyses of health insurance market structure, change and performance. State insurance markets are not well understood and have seldom been systematically studied in a manner that can inform public policy discussions and development. These products will contribute significantly to the public's understanding of how insurance markets are changing.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Finan, Stephen
202-690-7387

PIC ID: 7160

PERFORMER: Alpha Center
Washington, DC

EXPECTED DATE OF COMPLETION: 01/31/2000

Understanding Health Plan Accreditation and Its Potential to Promote the Consumer Bill of Rights and Responsibilities

The purpose of this project is (1) to provide policy and regulatory staff in the US Department of Health and Human Services (HHS) with an in-depth understanding of the aspects of the health plan accreditation process most closely related to the Consumer Bill of Rights and Responsibilities (CBRR); and (2) to determine the extent to which health plan accreditation fosters implementation of the CBRR. The study's results will provide useful feedback to the individuals and entities involved in developing the CBRR–by illustrating difficulties that accrediting organizations and health plans may face in operationalizing CBRR provisions.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Bayer, Ellen
202-690-7804

PIC ID: 7346

PERFORMER: Mathematica Policy Research, Inc.
Washington, DC

EXPECTED DATE OF COMPLETION: 03/31/2000

Human Services Policy

A Research Synthesis of the Findings from ASPE's "Leavers" Grants

This study will critically analyze and synthesize the findings of ASPE's grants that have studied welfare outcomes for individuals and families who have left cash assistance under the Temporary Assistance for Needy Families (TANF) program. The project will result in an Initial Synthesis Report and a Final Report. The Office of the Assistant Secretary for Planning and Evaluation (ASPE) awarded grants to states and counties to study the outcomes of welfare reform on individuals and families who leave TANF, individuals and families entering the caseload, and TANF applicants and potential TANF applicants. All of the grantees are using a combination of linked administrative data and surveys to study the outcomes of the TANF "leavers." The grantees include: Arizona, Cuyahoga County, District of Columbia, Florida, Georgia, Illinois, Los Angeles, Massachusetts, Missouri, New York, San Mateo County, Washington, and Wisconsin. Additional information about these grants, including grantee interim and final reports, are available at ASPE's leavers website: http://aspe.hhs.gov/hsp/leavers99/index.htm.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Lyon, Matthew
202-401-3953

PIC ID: 7368

PERFORMER: Urban Institute
Washington, DC

EXPECTED DATE OF COMPLETION: 06/30/2001

Abstinence-based Teen Pregnancy Prevention Efforts Targeting Boys

The purpose of this project is to: (1) identify abstinence-based pregnancy prevention programs that target boys or both boys and girls; (2) utilize a framework to assess and summarize the state of the field; and (3) provide the information in a format useful to state, local, and community policy-makers. Adolescent pregnancy is a complex issue, and understanding its causes, as well as effective prevention strategies, is still not well-developed. Traditionally, adolescent pregnancy prevention research and programs have focused on adolescent girls. It is becoming increasingly clear, however, that adolescent boys and young men must share that focus. At the same time, there has been a recent influx of funding for programs that use an abstinence- based approach. States and communities have shown an interest in providing services and programs for boys and young men, but have also expressed frustration that they do not have access to information about what strategies have been tried, if these have been successful, and how they can access funding for the development and operation of these programs. The project will result in a final report identifying existing abstinence-based teen pregnancy prevention efforts undertaken by youth organizations serving boys, target populations, and results of any evaluation activities. It will include information on issues of approach, cost, target group, impact, community support, geography, race/ethnicity, and special needs. This project is an integral part of the Department of Health and Human Services' (HHS) National Strategy to Prevent Teen Pregnancy and the Clinton Administration's Fatherhood Initiative.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Chessen, Sonia
202-690-8471

PIC ID: 6726

PERFORMER: South Bronx Overall Economic Development Corporation
Bronx NY

EXPECTED DATE OF COMPLETION: 09/30/2000

Child Outcome Study of the National Evaluation of Welfare-to-work Strategies: Two-Year Impacts

The Child Outcomes Study is a substudy of the National Evaluation of Welfare-to-Work Strategies (NEWWS), a longitudinal evaluation of a set of welfare-to-work strategies implemented under the Job Opportunities and Basic Skills Training (JOBS) Program as a part of the 1988 Family Support Act. In the three sites selected for the Child Outcomes Study--Atlanta, GA; Grand Rapids, MI; and Riverside, CA--the evaluation is examining the impacts of two types of welfare-to-work approaches. The "labor force attachment (LFA) approach" encourages a rapid transition into the labor force, whereas the "human capital development (HCD) approach" follows a long-term strategy of investing in recipients' basic education, with the aim of increasing qualifications for higher wage jobs. The Child Outcomes Study seeks to evaluate the impacts of each strategy on children's development and behavior in three domains: (1) cognitive development and academic achievement, (2) behavioral and emotional adjustment, and (3) physical health and safety. It will examine which maternal, family, and contextual characteristics help to explain these impacts on children. Background information is included on such topics as: (1) mothers' educational attainment, (2) current and previous employment, (3) welfare history, (4) household composition, (5) psychological well-being, and (6) welfare-related attitudes. This and other information (e.g., parenting, child care, father involvement) was collected at two and five years after random assignment from administrative records and in-home surveys. In addition, the five-year follow-up will survey teachers about children's school progress and behavior. Funding for this project was provided in part by the Administration for Children and Families.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Mirsky-Ashby, Audrey
202-401-6640

PIC ID: 6576.4

PERFORMER: Child Trends, Inc.
Washington, DC

EXPECTED DATE OF COMPLETION: 02/28/2000

Diagnosed Health Conditions and Health Care Service Utilization of Children in Foster Care

This project will conduct a study of health care issues regarding children in foster care. The study will use State Medicaid Research Files (SMRF) for three States to examine the extent of diagnosed illness and disability among children in foster care and the receipt of health care by these children. SMRF data includes information on health care claims made through the Medicaid program as well as information regarding the diagnoses associated with those claims. The study will examine questions regarding: (1) the extent of diagnosed illness and disability among children in foster care as compared to other children on Medicaid; (2) receipt of health care services including acute care, care for chronic health conditions and preventive services; (3) receipt of health care services following transitions into and out of foster care; and (4) subgroups of children in foster care, such as adolescents' use of substance abuse treatment and/or pregnancy-related services.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Radel, Laura
202-690-5938

PIC ID: 7149

PERFORMER: Mathematica Policy Research, Inc.
Washington, DC

EXPECTED DATE OF COMPLETION: 12/20/1999

Disaggregating the TANF Child-Only Caseload in Three States

The purpose of this study is to give the Department of Health and Human Services more detailed information about the make- up and trends of the Temporary Assistance for Needy Families (TANF) child-only population three States. Child-only cases are those in which benefits are paid only on behalf of minor children, and there are no adults in the household receiving assistance. In some cases the children are living with adults other than their parents. In such a case, the caretaker receives assistance on behalf of the child, but not for himself/herself. In other cases, a parent is in the household but is ineligible for benefits for one of several reasons, including: (1) receipt of SSI, (2) unqualified alien status, or (3) imposed sanctions. Such cases currently make up 21 percent of the TANF caseload, a proportion which has grown significantly in recent years. This study will use administrative data, case file reviews, and interviews with program and policy staff in three States to provide a better understanding of the issues regarding child-only TANF cases.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Radel, Laura
202-690-5938

PIC ID: 7188

PERFORMER: The Lewin Group
Fairfax, VA

EXPECTED DATE OF COMPLETION: 12/20/1999

Domestic Violence and Welfare: An Early Assessment

This project will study early implementation of the Temporary Assistance for Needy Families (TANF) Family Violence Option and child support enforcement program responses, including the use of good cause waivers for battered women. Evidence suggests that some battered women seek employment and child support while others need specialized assistance in addressing partner abuse. To address domestic violence, States may have policies regarding screening and other forms of identification, assessment of a battered woman's needs, service provision, confidentiality, corroboration required, staffing arrangements, agreements with community resources and other considerations. The study will provide information about these policy issues, the status of program implementation and descriptions of useful models.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Silverman, Gerald
202-690-5654

PIC ID: 6724

PERFORMER: Urban Institute
Washington, DC

EXPECTED DATE OF COMPLETION: 04/30/2000

Economic and Health Status of Immigrants, Their Communities, and the Organizations that Serve Them

This project will conduct research on the economic and health status of immigrants, their communities and the organizations serving them. The research will profile the status of immigrants with regard to health, employment and participation in programs administered by public and private agencies, with special attention to distinguishing categories of immigrants and drawing comparisons with the Native population. The project will also explore the impacts of welfare reform on immigrants and organizations, with special attention to both individual and institutional adaptations. Since the loss of food stamps appears to be the most far-reaching and permanent change affecting current legal immigrants, its impact on immigrants and their families will be a particular focus of the study. The project will supplement an examination of existing secondary data with intensive secondary data collection in Los Angeles and New York, the two cities that together account for one-fourth of the immigrant population. Primary data collection in the two cities has been designed to develop profiles of immigrants in these cities and the agencies serving them. This effort has several components, including: (1) interviews with 1,200 immigrant households in each city; (2) telephone interviews with most of the non-profit agencies providing services to immigrants; (3) in-depth interviews with 100 immigrants who lose Food Stamps and with additional immigrants who retain food stamps in each city; and (4) in-depth interviews with administrators and staff in public and private agencies.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Nielsen, David
202-401-6642

PIC ID: 6747

PERFORMER: Urban Institute
Washington, DC

EXPECTED DATE OF COMPLETION: 10/01/2000

Indicators of Welfare Dependence, March 2000

The Welfare Indicators Act of 1994 requires the Department of Health and Human Services to prepare annual reports to Congress on indicators and predictors of welfare dependence. Each annual Report on Welfare Indicators is developed with the advice and recommendations of the bipartisan Advisory Board on Welfare indicators, the assistance of the U.S. Department of Agriculture, the Social Security Administration and the U.S. Bureau of the Census. The purpose of this report, as stated in the law, is "to provide the public with generally accepted measures of welfare receipt so that it can track such receipt over time and determine whether progress is being made in reducing the rate at which and, to the extent feasible, the degree to which, families depend on income from welfare programs and the duration of welfare receipt."

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Isaacs, Julia
202-690-6805

PIC ID: 7281

PERFORMER: Office of the Assistant Secretary for Planning and Evaluation, Office of Health Policy
Washington, DC

EXPECTED DATE OF COMPLETION: 03/30/2000

Integration of Welfare and Workforce Development Systems

This study will: (1) build on research which examined State-level coordination and integration, and (2) provide an examination, using a case study approach, of the ways in which welfare agencies are working with other organizations involved in workforce development at the local level. It will provide additional insights into possible implications of various approaches to integration for individuals who are receiving public cash assistance through the Temporary Assistance to Needy Families (TANF) program, and who must seek employment and move toward economic self-sufficiency in a time-limited welfare environment. In addition to providing current information for policymakers and program administrators regarding the challenges to coordination and integration and lessons learned by local officials, the study will help to identify issue areas requiring in-depth study.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Mirsky-Ashby, Audrey
202-401-6640

PIC ID: 7144

PERFORMER: Urban Institute
Washington, DC

EXPECTED DATE OF COMPLETION: 02/28/2000

Making Ends Meet: How Mothers Manage When Their Welfare Grants Are Cut

This study will describe how family life adjusts to sanctions, through collection of in-depth qualitative data from mothers who are currently experiencing a cut in their welfare budget due to an imposed sanction. The data will include details on: (1) changes in financial resources, (2) how family members are affected, (3) where families turn for additional support, (4) additional reported and unreported employment activity, (5) mothers' perceptions about conflicts between work and family responsibilities, and (6) perceptions about the availability of affordable child care.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Kaye, Kelleen
202-401-6634

PIC ID: 6893

PERFORMER: Columbia University
New York, NY

EXPECTED DATE OF COMPLETION: 09/30/2000

National Evaluation of Welfare-to-Work Strategies (NEWWS)

The Department of Health and Human Services (HHS) is undertaking a study of the effectiveness of welfare-to-work programs. as part of the National Evaluation of Welfare-to-Work Strategies (NEWWS), the effects of two approaches to preparing welfare recipients for employment will be compared in three sites (Atlanta, Grand Rapids, and Riverside). In one approach, the human capital development approach, individuals are directed to avail themselves of education services and, to a lesser extent, occupational training before they seek work, under the theory that they will then be able to get better jobs and keep them longer. In the other approach, the labor force attachment approach, individuals are encouraged to gain quick entry into the labor market, even at low wages, under the theory that their work habits and skills will improve on the job and they will thereby be able to advance themselves. The evaluation uses a random assignment design in order to get reliable results. Sample members are being followed for five years from the time they entered the study. Comprehensive data on economic outcomes, including information on quarterly Unemployment Insurance-reported earnings and monthly Temporary Assistance for Needy Families (TANF) and Food Stamp payments is being collected.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Mirsky-Ashby, Audrey
202-401-6640

PIC ID: 7089

PERFORMER: Manpower Demonstration Research Corporation
New York, NY

EXPECTED DATE OF COMPLETION: 06/30/2001

Pregnancy Prevention Programs Targeting Boys and Young Men: Policy Information Dissemination Strategy

This project will develop a research and policy information strategy to inform regional, State, and local policy officials and community-based organizations serving children and youth of the program models, primarily directed at boys and young men, that can be implemented to help teenagers avoid premature sexual activity and unintended pregnancies. Project staff will: (1) review activities within the Department of Health and Human Services (HHS) and outside the Federal government to collect information about pregnancy prevention activities targeted at boys and young men; (2) meet with national, State, and community leaders to determine information needs; (3) develop information packets; and (4) test strategies to get information to State and community decision makers in a timely and usable format. This project is an integral part of the National Strategy to Prevent Teen Pregnancy and the Clinton Administration's Fatherhood Initiative, which promotes delaying fatherhood until a man is emotionally and financially ready, and encourages fathers to take a more active role in providing support and guidance to their children. It is also being undertaken in collaboration with the activities of the non-profit, non- partisan National Campaign to Prevent Teen Pregnancy.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Mellgren, Linda
202-690-6806

PIC ID: 6766

PERFORMER: Urban Institute
Washington, DC

EXPECTED DATE OF COMPLETION: 02/28/2000

Study of Welfare-to-Work Programs Serving Non-Custodial Parents

The U.S. Department of Labor's Welfare-to-Work (WtW) grants program provides funds to states and local organizations to support efforts to help the hardest-to-employ recipients of Temporary Assistance for Needy Families (TANF), as well as certain non custodial parents, get and keep jobs. Recent changes to the WtW eligibility criteria have reemphasized the importance of non custodial parents (NCPs) as a key population in need of WtW interventions. By targeting NCPs, the WtW program aims to increase absent fathers' involvement with their children's lives and their commitment to their families' economic and personal well-being. This study was initiated by the Assistant Secretary for Planning and Evaluation (ASPE) of Health and Human Services (HHS) to identify and describe some of the WtW programs serving NCPs. The study will gather and present information on a variety of program models and service approaches that can help guide the larger community of social service and workforce development agencies in their efforts to serve the needs of non custodial parents and their families. The study will focus on how WtW grantees serving NCPs design and implement their programs, identify and recruit their clients, and develop partnerships with other organizations serving NCPs such as the local child support enforcement and TANF agencies.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Landey, Alana
202-401-6636

PIC ID: 7086

PERFORMER: Mathematica Policy Research, Inc.
Washington, DC

EXPECTED DATE OF COMPLETION: 11/01/2000

The National Evaluation of the Welfare to Work Grants Program

The Balanced Budget Act of 1997 authorized the Department of Labor to award $3 billion in welfare-to-work grants to States and local communities to promote job opportunities and employment preparation for the hardest-to-employ recipients of Temporary Assistance for Needy Families (TANF), and for non-custodial parents of children on TANF. This project will evaluate the effectiveness of welfare-to-work initiatives, including those undertaken by the welfare-to-work grantees and by American Indian and Alaska Native (AI/AN) tribal organizations. The Department of Health and Human Services (DHHS), in conjunction with the Departments of Labor and Housing and Urban Development, has designed an evaluation to address five key questions: (1) What are the types and packages of services provided by welfare-to-work grantees? (2) What are the net impacts of various welfare-to-work program approaches on employment and on family well-being? (3) What challenges are confronted as grantees implement and operate the programs? (4) Do the benefits of the programs outweigh the costs? and (5) How well do private industry councils and other non-TANF organizations meet the challenges of implementing the programs for the hard to employ? The evaluation study includes four main components: (1) a descriptive assessment of all welfare-to- work grantees based on mail surveys and site visits; (2) in-depth impact and cost-effectiveness study; (3) in-depth process and implementation study; and (4) a special process and implementation study focusing on tribal welfare and employment systems.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Landey, Alana
202-401-6636

PIC ID: 7147

PERFORMER: Mathematica Policy Research, Inc.
Washington, DC

EXPECTED DATE OF COMPLETION: 10/20/2003

The Role of Intermediaries in Welfare to Work

Moving millions of welfare recipients into the workforce is the cornerstone of the recently enacted welfare reform legislation, the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996. Efforts to employ welfare recipients under PRWORA will not be successful without the involvement and support of private sector employers. Across the country, businesses are getting involved to varying degrees in welfare-to-work, including more than 2,500 member companies of the Welfare to Work Partnership who have pledged their commitment to hire welfare recipients. Many of these businesses are in turn relying on intermediaries to help them hire welfare recipients. The role of intermediaries varies significantly, from providing referrals or assistance with filing for tax credits, to providing extensive pre and post-employment services. While the importance of intermediaries is growing rapidly, little is known about them. This study provides two types of information on intermediaries. The first is a broad description of the types of intermediaries currently participating in welfare-to-work efforts in several sites across the country. This information will be presented for a large number of intermediaries, but will be fairly general, focusing on the basic characteristics of the intermediaries and the types of services provided. The second part of the project will present in-depth information on implementation issues based on site visits to the communities of approximately ten of these intermediaries.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Kaye, Kelleen
202-401-6634

PIC ID: 7151

PERFORMER: Mathematica Policy Research, Inc.
Washington, DC

EXPECTED DATE OF COMPLETION: 10/20/1999

Welfare Outcomes Panel Study

The Office of the Assistant Secretary for Planning and Evaluation (OASPE) is conducting a panel study with the National Academy of Sciences (NAS) to evaluate the design of current, proposed and future studies of the effects of the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996. This panel study will assist the department in: (1) reviewing existing research efforts on the effects of welfare reform; (2) examine the appropriate data sources, research designs and statistical methods for analyzing welfare reform outcomes; and (3) identify research gaps and data needs for the continued study of welfare reform. Specific topics to be covered by the panel of experts include: (1) the appropriate outcome measures needed to effectively evaluate the outcomes of welfare reform; (2) the appropriate population of study; (3) the design and usefulness of existing national-level surveys (e.g., the Survey of Program Dynamics and the Survey of Income and Program Participation); (4) data needs for monitoring State and sub-State variation in outcomes; (5) potential uses and limitations of administrative data; and (6) integration of survey and administrative data. Over the course of the study, the NAS expert panel will address the above mentioned tasks through workshops, quarterly panel meetings and the publication of both an interim report and a final report. The interim report (see PIC # 7145.1) included early recommendations of the panel and the final report will document the comprehensive list of final recommendations to the department.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Hauan, Susan
202-690-8698

PIC ID: 7145

PERFORMER: National Academy of Sciences
Washington, DC

EXPECTED DATE OF COMPLETION: 03/02/2001

Welfare Reform and Changing Program Participation Patterns in Four States

The purpose of this study is to understand how families' use of a variety of safety net programs changes over time as welfare reform is implemented. This will be an early look at how welfare waivers and the welfare reform law influenced families' program participation. Using administrative data in four States from 1994-1997, the study will examine a series of questions regarding whether families' program participation patterns change in response to program eligibility changes and policy shifts. It will examine the child and family outcomes in such areas as family self sufficiency, child living arrangements and child abuse and neglect reports. The study's unique contribution will be its effort to look at families' pathways across a series of safety net programs.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Feig, Laura
202-690-5938

PIC ID: 7148

PERFORMER: Chapin Hall Center for Children, University of Chicago
Chicago, IL

EXPECTED DATE OF COMPLETION: 10/20/1999

Program Systems

Community and Neighborhood-Level Performance Indicators for Human Services

This project will develop information about the use of community-level performance indicator systems and facilitate information sharing among the many organizations currently influencing how those systems address human services and health issues. A source book will be compiled on community level program performance indicators for key human services and health topics, including a listing of organizations that are formulating model indicator systems and a description and analysis of a sample of each organization's proposed indicators. The project will also support a one-day invitational workshop in Washington, D.C. for DHHS personnel, representatives of organizations currently involved in creating community-level indicators or indicator systems, and representatives of local government agencies. The purpose of the workshop is to discuss development and use of community-level performance indicators and explore the potential for consolidating existing indicator systems in areas where they duplicate or overlap each other.

AGENCY SPONSOR: Office of Program Systems

FEDERAL CONTACT: O'Connell, Mary Ellen
202-260-0391

PIC ID: 7359

PERFORMER: Research Triangle Institute
Research Triangle Park, NC

EXPECTED DATE OF COMPLETION: 09/30/2000

Evaluation Synthesis to Support the Food Safety Strategic Plan

This project will support evaluation syntheses for the President's Council on Food Safety and the Development of the Food Safety Strategic Plan for FY 2000. The President's Council is comprised of representatives from HHS, USDA, EPA, and the White House. Evaluation syntheses will bring together existing studies, assesses them, and use them as a database for answering questions about the effectiveness or efficacy of programmatic strategies to achieve food safety objectives. Results from the syntheses will be used to help refine statements of strategic objectives in the plan, identify existing programs and new resources required to achieve the objectives, and cite evidence in the plan of the likely success of strategies to achieve the objectives. The evaluation syntheses will focus on HHS program activities in four food safety goal areas: risk assessment, risk management, and risk communication, and organizational strategies.

AGENCY SPONSOR: Office of Program Systems

FEDERAL CONTACT: Johnson, Paul
202-401-8277

PIC ID: 7360

PERFORMER: Research Triangle Institute
Research Triangle Park, NC

EXPECTED DATE OF COMPLETION: 09/30/2000

Mississippi Community Works HELP DESK - (MS-CWHD)

The DELTA project will establish an interactive, multi-sectoral Help Desk in Jackson, Mississippi, to assist and support the EZ/EC/Champion Communities in furthering their strategic plans. The Help Desk will provide access to, and technical assistance with, tested strategies and model programs, best practices and lessons learned related to a variety of economic and social development issues. It will also provide information about, and access to, external resources, both funding and programmatic, to serve as partners in the implementation of development initiatives planned by these communities. An evaluation will be conducted during the course of the Help Desk project to include site visits, client surveys and telephone interviews, in order to determine impact and track progress on established outcomes for these communities. An interim evaluation report is due to be completed in October 1999.

AGENCY SPONSOR: Office of Program Systems

FEDERAL CONTACT: Gatz, James K.
202-260-0397

PIC ID: 7213

PERFORMER: C.J. Quinn and Associates

Annapolis, MD

EXPECTED DATE OF COMPLETION: 09/30/2000

Research Consultation on Review of HHS Services Research, Demonstrations, and Evaluations Targeted to Hispanic/Latino Americans

The purpose of this project is to obtain consultation for a review of the various health services and social services research programs, demonstration grant programs, policy studies and evaluation projects targeted toward Hispanic/Latino Americans. Consultants with research expertise in Hispanic/Latino health and human service needs and delivery system issues will conduct a review to determine gaps in knowledge and make recommendations for future research priorities.

AGENCY SPONSOR: Office of Program Systems

FEDERAL CONTACT: Johnson, Paul
202-401-8277

PIC ID: 6698

PERFORMER: Interuniversity Program for Latino Research
Austin TX

EXPECTED DATE OF COMPLETION: 09/30/2000

State Telephone Survey Estimates for Evaluation and Monitoring

This project, funded by the Office of the Assistant Secretary for Planning and Evaluation (ASPE) and carried out by the National Center for Health Statistics (NCHS), develops and evaluates an integrated survey mechanism to collect broad State- based health and human services data. It also evaluates the quality and utility of State-level estimates developed from telephone surveys alone and in conjunction with, estimates obtained from the National Health Interview Survey (NHIS). A variety of health and human services data estimates for a selected number of States will be obtained through a telephone interview survey based on the NHIS questionnaire and selected supplemental data.

AGENCY SPONSOR: Office of Program Systems

FEDERAL CONTACT: Scanlon, James
202-690-7100

PIC ID: 6420

PERFORMER: National Center for Health Statistics
Hyattsville MD

EXPECTED DATE OF COMPLETION: 07/31/2000

Office of Public Health and Science

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.

The FY 1999 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 Surgeon General and 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 Women’s Health, Minority Health, Disease Prevention and Health Promotion, Research Integrity, and Emergency Preparedness. 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).

Fiscal Year 1999 Evaluation Reports

Cross-Cutting

Welfare Reform Conference: Summary Report

The Regional Health Administrator, Public Health Service (PHS) Region V, in collaboration with the Public Health Practice Program Office of the Centers for Disease Control and Prevention (CDC), will provide partial support for a project entitled, "Welfare Reform: Early Detection, Prevention, and Health Promotion Interventions for Local Health Departments in Alabama". The University of Alabama School of Public Health, in collaboration with the Alabama Department of Public Health, conducted a one-day conference at the Bell South Operations Center in Birmingham on April 22, 1998 for 155 sub- State public health administrators, supervisory nursing and social work personnel, and senior state staff. The conference ensured that participants: (1) understood provisions of the new welfare legislation affecting public health systems, (2) recognized events and trends in the health status of local populations affected by the new welfare legislation, (3) employed appropriate prevention and health education strategies to mitigate negative effects of the new welfare legislation, and (4) assessed the effects of their interventions. Satellite downlinks extended the conference to staff of most county health departments in the state. Pre- and post-test questionnaires assessed gains in participant knowledge. A post-conference survey identified improvements in job performance and public health practice relative to conference objectives.

AGENCY SPONSOR: Office of the Regional Director, Region V

FEDERAL CONTACT: Cobb, Clara
404-562-7904

PIC ID: 6686

PERFORMER: University of Alabama, School of Public Health
Birmingham, AL

Health Promotion

Wired for Health and Well-Being: The Emergence of Interactive Health Communication

Interactive Health Communication (IHC) is the interaction of an individual--consumer, patient, caregiver, or professional-- with or through an electronic device or communication technology to access or transmit health information, or to receive or provide guidance and support on a health-related issue. IHC applications include health information and support websites and other technology-mediated applications that relay information, enable informed decisionmaking, promote healthy behaviors, promote information exchange and support, promote self-care, or manage demand for health services. The rapid evolution of IHC raises many questions about its impact on public health and health care and our ability to evaluate it. This report summarizes the potential risks and benefits of IHC, the underlying science or evidence base for IHC, mechanisms for improving IHC quality and effectiveness, appropriate roles and responsibilities for IHC stakeholders, and relevant major policy and research issues. The report also presents the Panel's consensus recommendations about national initiatives that are needed to achieve a preferred future for IHC.

AGENCY SPONSOR: Office of Disease Prevention and Health Promotion

FEDERAL CONTACT: Deering, Mary Jo
202-260-2652

PIC ID: 6327

PERFORMER: Social and Health Services, Ltd.
Rockville MD

Healthy People 2010

Getting Started for 2010

Through a series of audio conferences, the Public Health Foundation (PHF), under contract with the HHS Office of Disease Prevention and Health Promotion, provided technical supports to states, localities, and communities in establishing and measuring their 2010 health objectives. The first program, which specifically targeted State and territorial Healthy People State contacts, provided an overview of Healthy People 2010, facilitated States' involvement in the national objectives review and comment process, and engaged participants in a discussion of the facilitators and barriers to objectives development at the State level. Subsequent audioconferences focused on more specific topics such as data needs and resources, State/local linkages, and developing State plans. Information presented through these programs and gathered through participant feedback were organized and made available to States and localities to provide continued technical assistance in setting 2010 health objectives. This project produced five reports. (See also 6326, 6326.1)

AGENCY SPONSOR: Office of Disease Prevention and Health Promotion

FEDERAL CONTACT: Guidry, Matthew

202-401-7780

PIC ID: 6326.2

PERFORMER: Public Health Foundation
Washington, DC

Leading Health Indicators for Healthy People 2010: Final Report

Healthy People is well established as the Nation's prevention agenda and as a scorecard for monitoring health status. The development of new national goals and objectives for 2010 provided an opportunity to build upon Healthy People by identifying a small set of health indicators that would be understandable to the public and could be used to reflect and draw public attention to progress. These indicators should increase understanding of Healthy People and should be a useful tool for monitoring America's health. Because the leading health indicators form a highly visible and potentially actionable part of the Nation's health objectives for 2010, it was important that the indicators reflect the input of the scientific community as well as policymakers and the public. Thus, the Institute of Medicine convened a panel of experts in public health practice, epidemiology, data sources, performance monitoring, statistics, public policy, among others to develop criteria for leading health indicators and proposed three sets: Health Determinants and Outcomes, Life Course Determinants, and Prevention- Oriented. HHS drew on the IOM recommendations to identify the 10 Healthy People 2010 Leading Health Indicators.

AGENCY SPONSOR: Office of Disease Prevention and Health Promotion

FEDERAL CONTACT: Meyers, Linda D.
202-401-6295

PIC ID: 7030

PERFORMER: National Academy of Sciences, Institute of Medicine
Washington, DC

Minority Health

Assessment of Linguistically and Culturally Appropriate Community Health Promotion Programs in Local Health Departments

Baseline data for Healthy People 2000 objective 8.11 (By the year 2000, increase to at least 50% the proportion of counties that have established culturally and linguistically appropriate community health promotion programs for racial and ethnic minority populations) has been unavailable to date due to definitional problems with "culturally and linguistically appropriate community health promotion programs" and lack of a data source. This project supported efforts by the National Association of County and City Health Officials (NACCHO) to include in their regularly conducted stratified sample surveys of local health departments (LHDs) questionnaire items that would provide data that can be used as a proxy baseline for this objective. Through key informant interviews, a set of questions were formulated and included in a NACCHO survey of the nature and extent of the interventions under study being provided by a random sample of LHDs serving communities with 10 percent or more racial/ethnic minority populations. The study found that most LHDs provide some sort of culturally sensitive and linguistically appropriate intervention in the areas of health promotion and preventive services. However, these culturally and linguistically appropriate interventions do not necessarily constitute formal, structured "community health promotion programs" and, in any event, fall far below the 50 percent target set in the Healthy People objective. This study provides the baseline to measure the objective and sets the stage for additional contextual research to be conducted on the provision of cultural and linguistic services to racially and ethnically diverse populations.

AGENCY SPONSOR: Office of Minority Health

FEDERAL CONTACT: Pacheco, Guadalupe
301-443-5084

PIC ID: 6798

PERFORMER: National Association of County and City Health Officials NACCHO
Washington, DC

Cultural and Linguistic Competence Standards and Research Agenda Project (Parts I and II)

This project was designed to: (1) support the examination of completed and ongoing efforts that measure culturally and linguistically appropriate services (CLAS) in health care and that link such measurement to patient and/or health outcomes, and (2) propose a research agenda to strengthen the science in support of CLAS health care. An analytical review was conducted of key CLAS-related laws, regulations, contracts and standards currently in use by Federal and State agencies and other national organizations. This review--coupled with input from a national advisory committee of policymakers, health care providers and researchers with expertise in cultural competency--resulted in the development of 14 proposed standards for CLAS in health care which largely reflect current policies, regulations and practice in this area. Written commentary is provided in Part I of the final report that addresses each proposed standard and its relationship to existing laws, regulations, standards, etc. Recommendations are also offered for implementation and oversight. Information and research needed to relate these standards to health impacts and outcomes, along with key research areas and questions, are presented in Part II. An attempt is also made to set the stage for an ongoing discussion of research concerns surrounding CLAS, including general issues, methodological concerns, potential research approaches and agenda setting. Existing research examined relating CLAS to health outcomes generally indicates that lack of attention to cultural issues leads to less than optimal health care, and that use of certain CLAS interventions leads to improved outcomes. However, it also reflected a clear need for more and better research in this regard. Additional support will be needed to establish the draft standards as national "model standards" for cultural competency and to develop a robust research agenda to strongly link CLAS to health outcomes.

AGENCY SPONSOR: Office of Minority Health

FEDERAL CONTACT: Pacheco, Guadalupe
301-443-5084

PIC ID: 6675

PERFORMER: Center for the Advancement of Health
Washington, DC

Public Health Infrastructure

Examining Data Sharing Among State Governmental Health Agencies

Data that exist in a single agency, or in a single program of an agency, are no longer seen as sufficient to document the impact of increasingly complex programs or to answer the complex questions being asked about the impact of these programs. This report gathered information on how State health departments and mental health, substance abuse, and Medicaid agencies use and share existing data. The study examined the use and sharing of data in six States -- California, Massachusetts, Missouri, South Carolina, Utah, and Washington -- considered potential models for how to use data across State agencies. Overall, the study found that data sharing among State government health agencies is not occurring on a routine basis. These State agencies predominantly use only their own data, supplementing these data with data from other sources on an infrequent basis. One formidable barrier cited about data sharing, described by study respondents, was the lack of formal agreements between agencies for the purposes of data sharing. The report concludes with a list of 15 policy recommendations. The Public Health Functions Working Group and Steering Committee, with representatives from all of the former agencies of the Public Health Service, provided guidance to the project. (See PIC ID 6326.1 and 6326.2)

AGENCY SPONSOR: Office of Disease Prevention and Health Promotion

FEDERAL CONTACT: Gottfried, Kate
202-401-6295

PIC ID: 6326

PERFORMER: Public Health Foundation
Washington, DC

In-Progress Evaluations

Health Promotion

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 requires that: (1) evaluates requirements and dietary and supplement intake data for nutrients and non-nutrient food components, (2) develops Dietary references intakes 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). Evaluations are underway on micro nutrients (9/98 to 12/00) and macro nutrients (fat, carbohydrate, protein (9/99 -6/00).

AGENCY SPONSOR: Office of Disease Prevention and Health Promotion

FEDERAL CONTACT: Castro, Elizabeth C.
202-401-5811

PIC ID: 6323

PERFORMER: National Academy of Sciences, Institute of Medicine
Washington, DC

EXPECTED DATE OF COMPLETION: 06/29/2002

Minority Health

A Nat. Assessment of Culturally and Linguistically Appropriate Serv. in Managed Care Organizations Serving Racially and Ethnically DIv. and Vul. Pops.

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.

AGENCY SPONSOR: Office of Minority Health

FEDERAL CONTACT: Hawks, Betty
301-443-5084

PIC ID: 6674

PERFORMER: Cosmos Corporation
7474 Bethesda, MD

EXPECTED DATE OF COMPLETION: 04/30/2001

Assessment of State/Territorial Minority Health Infrastructure and Capacity to Address Issues of Health Disparity

This project will: (1) examine the nature and extent of the minority health infrastructure within State public health agencies; (2) determine those factors that contribute to, or detract from, establishment and sustained support for such entities; and (3) assess the viability of and effects on State capacity to address the needs of racial and ethnic minorities in carrying out the essential services of public health and issues of disparities in health status and risks to health.

AGENCY SPONSOR: Office of Minority Health

FEDERAL CONTACT: Maccannon, Gerrie
301-443-5084

PIC ID: 7014

PERFORMER: Office of Minority Health
Rockville, MD

EXPECTED DATE OF COMPLETION: 02/29/2000

Data Analysis and Support for the President's Initiative on Race

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 state of race relations formed the introductory chapter(s) of the Advisory Board's report. In addition, the White House commissioned the National Academy of Sciences to prepare detailed summaries of the research literature related to race and health. To support the Department's Initiative to Eliminate Racial and Ethnic Disparities in Health community demonstration grant program, the project will identify relevant departmental data systems and perform preliminary analyses to support the grant program.

AGENCY SPONSOR: Office of Minority Health

FEDERAL CONTACT: Carter-Pokras, Olivia
301-443-9923

PIC ID: 7014

PERFORMER: Office of Minority Health
Rockville, MD

EXPECTED DATE OF COMPLETION: 09/30/2000

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.

AGENCY SPONSOR: Office of Minority Health

FEDERAL CONTACT: Woo, Violet
301-443-9923

PIC ID: 7097

PERFORMER: Development Services Group, Inc.
Bethesda MD

EXPECTED DATE OF COMPLETION: 09/30/2001

Establishment of National Standards for Culturally and Linguistically Appropriate Health Services

In 1997, the Office of Minority Health, Office of Public Health and Science, U.S. Department of Health and Human Services, recognized the need for dialogue to address the issues of quality assurance, efficiency, and outcome measures related to the delivery of culturally and linguistically appropriate services. Specifically, OMH contracted with the Center for the Advancement of Health, Inc. (CAH), in partnership with the Resources for Cross Cultural Health Care (RCCHC), to: (1) examine completed and ongoing efforts that measure culturally and linguistically appropriate services (CLAS) in health care and that link the resulting measurement with patient and/or health outcomes. (2) propose a research agenda to strengthen the science in support of CLAS health care. As a result, 14 proposed standards were developed with input from a national advisory committee of policymakers, health care providers, and researchers with expertise in cultural competency. Examples of proposed standards include: the promotion and support of attitudes, behaviors, knowledge, and skills necessary for staff to work respectfully and effectively with patients and each other in a culturally diverse work environment and the ongoing education and training of all staff in CLAS delivery. A fuller description of the completed project may be obtained from PIC ID # 6675. This project seeks to further refine these draft standards through a public comment period to include opportunities for feedback from additional experts and the general public. Comments will be accepted via the Internet, by mail ,and at regional meetings that will be held in San Francisco, CA; Chicago, IL; and Washington, DC. At the conclusion of the public comment period, comments will be analyzed and integrated into the development of a final set of standards that will be national in scope and have national applicability, acceptability, and utility.

AGENCY SPONSOR: Office of Minority Health

FEDERAL CONTACT: Pacheco, Guadalupe
301-443-5084

PIC ID: 7260

PERFORMER: IQ Solutions, Inc.
Rockville, MD

EXPECTED DATE OF COMPLETION: 09/30/2000

Evaluation of the Office of Minority Health Resource Center--Phase I, Phase II and Phase III

The purpose of Phase I of this project is to develop and field test a research protocol including an information collection method and instrument that could be used to evaluate the Office of Minority Health Resource Center (OMHRC). Phase II of this project is to implement the research protocol developed in Phase I, intended to evaluate OMHRC. The Phase III of this project analyzed data and prepared analytical reports on data from a survey of actual and potential users of the OMHRC. Specifically, Phases I, II and III of this project collected, analyzed and reported data concerning: (1) the functions of OMHRC; (2) target audiences and services provided to these audiences; (3) how OMHRC assesses user and target audience needs, ability of the center to meet those needs, and satisfaction of users with center services, and ways to improve these assessments; (4) how OMHRC relates to other Federal and nonfederal information sources, including Federal clearinghouses, Federally supported health or human service offices, and Federal, State and local minority health offices; and (5) gaps in information dissemination that are not being addressed by Federal information sources. High percentages of consumers completing the survey instrument found the matters from the Resource Center use (96.1%) and a large majority (92.6%) were satisfied with the services received from the Center.

AGENCY SPONSOR: Office of Minority Health

FEDERAL CONTACT: Kelley, Howard L., D.D.S.
301-443-5224

PIC ID: 6244

PERFORMER: Research Triangle Institute
Research Triangle Park, NC

EXPECTED DATE OF COMPLETION: 03/31/2000

Public Health Infrastructure

County-Level Tracking of Public Health Functions and Policy Issues

This project will assure that documentation of budget and workforce capacity performance of essential public health services will be available regarding the twelve cities studied by the Center for Studying Health Systems Change's "Longitudinal Community Study." The longitudinal study is funded by the Robert Wood Johnson Foundation (RWJ) for at least four years, and will identify changes in the public health system over the same period.

AGENCY SPONSOR: Office of Disease Prevention and Health Promotion

FEDERAL CONTACT: Guidry, Matthew
202-401-7780

PIC ID: 6325

PERFORMER: Mathematica Policy Research, Inc.
Plainsboro, NJ

EXPECTED DATE OF COMPLETION: 09/30/2000

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.

AGENCY SPONSOR: Office of Disease Prevention and Health Promotion

FEDERAL CONTACT: Guidry, Matthew
202-401-7780

PIC ID: 6492

PERFORMER: Partnership For Prevention
Washington, DC

EXPECTED DATE OF COMPLETION: 09/30/2000

Substance Abuse and Mental Health Services Administration

MISSION: To improve the quality and availability of prevention, treatment, and rehabilitation services for substance abuse and mental illness.

Evaluation Program

The Substance Abuse and Mental Health Services Administration (SAMHSA) is committed to evaluating its overall programs and individual grant projects to assess the effectiveness of prevention, treatment, and rehabilitation approaches and systems of care; the accountability of Federal funds; and the achievement of SAMHSA's programmatic and policy objectives.

To the greatest extent appropriate and feasible, SAMHSA encourages the use of comparable data elements and instruments across its evaluations in order to work toward a comprehensive evaluation system and to minimize respondent burden.

SAMHSA conducts grant programs under a variety of legislative authorities. These authorities can generally be grouped into two types: (1) services and (2) knowledge development and application (KDA). The evaluation required for a particular grant program is dependent on the type and purpose of the program. SAMHSA evaluates each of its service programs so as to provide information to program managers about the accountability of Federal funds. In addition, the evaluations of KDA programs will generate new knowledge to lead the field in the development of policies that improve services.

The two types of grant programs (service delivery and KDA) represent the two facets of SAMHSA's mission. SAMHSA's leadership in the field depends on the successful interaction of these two facets. Through KDAs, SAMHSA must identify effective approaches to prevention, treatment, and rehabilitation. Through service delivery funds, SAMHSA must provide incentives to the field to implement effective approaches. Major emphases of SAMHSA's mission are to develop, identify, and disseminate effective strategies and systems for prevention, treatment, and rehabilitation.

SAMHSA is implementing an integrated model of evaluation and planning. Strategic planning identifies priorities, such as managed care, that drive the development of grant programs and evaluations. In compliance with the Government Performance and Results Act (GPRA), SAMHSA is improving performance management by identifying annual performance objectives and measures. The formulation of programmatic and evaluation priorities includes consultation with SAMHSA Center Advisory Councils, and with other experts in the fields of evaluation and service delivery. Early and continuous coordination of program planning and evaluation design will result in the articulation of program objectives that may be evaluated. Evaluations will demonstrate the extent to which the grant programs have achieved their overall objectives, and SAMHSA will translate these results into information that can be used for program and policy development. The strategic planning and policy development processes will then use these results to refine SAMHSA's priorities and performance objectives.

This evaluation policy will help SAMHSA achieve its goal of continually informing policy and program development with knowledge culled from past performance. In this way, SAMHSA can best serve its customers by enhancing the quality of publicly-funded substance abuse and mental health services.

In compliance with the Public Health Service (PHS) guidelines for the technical review of evaluations, SAMHSA has established a standing committee of PHS staff who are evaluation specialists. Representatives of the Office of the Assistant Secretary for Planning and Evaluation serve as ex officio members of the committee. The SAMHSA evaluation officer is the committee chair. The committee does not generally review the evaluation proposals of individual grantees; rather, it reviews proposals for broader, more comprehensive evaluations, such as the cross-project evaluations of grant programs.

Evaluation project proposals are generally prepared by SAMHSA program staff in the various Centers. The standing committee reviews each proposal on the following criteria: clarity of evaluation objectives and research questions, appropriateness and feasibility of the specifications for evaluation design and methods, appropriateness of the plans for dissemination of results, and use of previous relevant evaluations and existing program data systems. Each proposal must clearly state the relationship of the evaluation to SAMHSA's overall policies, priorities, and evaluation program.

Fiscal Year 1999 Evaluation Reports

Substance Abuse Treatment

A Profile of Clients Entering Treatment for Alcohol Problems

The National Evaluation Data Services (NEDS) of the Center for Substance Abuse Treatment (CSAT) conducted a secondary analysis of data collected in the National Treatment Improvement Evaluation Study (NTIES) to address the problems experienced by those who entered treatment for alcohol use. Results indicated that those using only alcohol tended to be older, more often white, somewhat more educated, and more likely to be employed before entering treatment. Those who used alcohol in addition to other drugs significantly reduced their consumption of drugs after treatment, but clients who had used only alcohol (who were by definition drug-free in the 12 months before treatment) showed minor but statistically significant post-treatment increases in various forms of drug use. With the exception of driving under the influence (DUI) and driving while intoxicated (DWI) offenses, clients who had used only alcohol exhibited fewer instances of criminal behavior and arrests before treatment. On the other hand, they were more likely to have been referred for treatment by the criminal justice system (presumably for these driving offenses) and less frequently sought treatment on their own. Nevertheless, all groups in the study demonstrated substantial reductions in criminal behaviors as well as improvement in general and mental health and employment circumstances during follow-up periods. No significant post-treatment reductions in the self-reported use of alcohol were observed among all concerned, although this finding may be of clinical significance only for those who entered treatment for alcohol use alone. Among the recommendations included a need to define "best practices" in the treatment of alcoholism, bearing in mind that the population of those whose problem is exclusively due to alcohol use may be "aging out".

AGENCY SPONSOR: Center for Substance Abuse Treatment

FEDERAL CONTACT: Smith, Ron
301-443-7730

PIC ID: 5994

PERFORMER: Caliber Associates
Fairfax, VA

Drug Use Prevalence Estimates Among Adult Arrestees in California, Texas and the U.S.: Final Report

Society continues to suffer the immense costs and consequences associated with drug use and crime. Drug use prevalence among arrestees has been 50-80 percent in some locations. Policy makers need better information about drug use among criminal populations to more effectively respond to these problems. This research project applied three types of synthetic estimation techniques to estimate the number of drug users in a larger population where the prevalence rates are not known. The report from this project was produced by the Department of Health and Human Services Center for substance Abuse Treatment, through the National Evaluation Data and Technical Assistance Center. To improve prevalence estimation methods, the UCLA Drug Abuse Research Center conducted an initial study of regression modeling to produce their estimates, which resulted in improved conceptualization and preliminary applications of a regression model. This report applies the same regression model to larger scale data and applies it to all jurisdiction levels. The major finding indicates multiple capture rates are significantly higher than those reported in the literature (typically 13%) and their rates dramatically differ by gender, race/ethnicity, and crime type. In conclusion, the report found regression models of synthetic estimation to be sensitive and capable of providing high-confidence estimates of drug use prevalence at local, state, and national levels.

AGENCY SPONSOR: Center for Substance Abuse Treatment

FEDERAL CONTACT: Smith, Ron
301-443-7730

PIC ID: 5994.6

PERFORMER: Caliber Associates
Fairfax, VA

Methadone Treatment Outcomes in the National Treatment Improvement Evaluation Study (NTIES)

This analytic report examines the outcomes of methadone-treated clients in the National Treatment Improvement Study (NTIES). It addresses two fundamental questions: "How much methadone treatment is required in order to achieve successful outcomes?" and "To what extent will favorable outcomes of methadone treatment persist following the client's termination from treatment?" The results were consistent with findings from other national studies which suggest that better treatment outcomes for outpatient methadone treatment clients are associated with both longer stays in treatment and still being in the program during follow-up. The current study found consistently favorable outcomes including reductions in drug use, HIV/AIDS risk, and reduced criminal behaviors for clients who were maintained on methadone for 12 or more months and discharged clients who were treated for 3 to 12 months. At the policy level, the findings provide support for the expansion of methadone treatment, the expansion of aftercare services for methadone treated clients and the expansion of ancillary services, such as transportation and day care. In terms of implications for practice, information and referral services should be provided to assist discharged clients locate alternative treatment resources.

AGENCY SPONSOR: Center for Substance Abuse Treatment

FEDERAL CONTACT: Smith, Ron
301-443-7730

PIC ID: 5994.5

PERFORMER: Caliber Associates
Fairfax, VA

Potential Sources of Bias in Substance Abuse Treatment Follow-up Studies

The National Evaluation Data Services (NEDS) of the Center for Substance Abuse Treatment (CSAT) explored two methodological issues of importance to substance abuse treatment researchers and policy analysts alike: a lack of response by a group of those under treatment whose behavior is being studied over time and selection bias in recruiting such study participants. The purpose of the study conducted was to determine the extent and effects of these two issues in a recent series of four large-scale follow-up studies: the California Drug Alcohol Treatment Assessment (CALDATA), the Services Research Outcomes Study (SROS), and the National Treatment Improvement Evaluation Study (NTIES), and the Drug Abuse Treatment Outcome Study (DATOS). Differences in follow-up response rates among these four studies appear to be due partly to differences in research design and partly to a difference between survey organizations in follow-up effectiveness. These and other findings as well as recommendations were issued. (See also PIC ID #s 5994.1-5994.3.)

AGENCY SPONSOR: Center for Substance Abuse Treatment

FEDERAL CONTACT: Smith, Ron
301-443-7730

PIC ID: 5994.3

PERFORMER: National Opinion Research Center (NORC)
Chicago, IL

Prospective and Retrospective Studies of Substance Abuse Treatment Outcomes: Methods and Results of Four Large-Scale Follow-Up Studies

An important service of the Center for Substance Abuse Treatment (CSAT) is to create more effective substance abuse treatment and recovery services by developing and analyzing good data on which to base such programs. One of the specific activities of the National Evaluation Data Services (NEDS), created by CSAT, is to pull together databases for broad analytic purposes or to house databases produced under a wide array of activities. This study conducted by NEDS compares research methods, provider and patient characteristics, and outcome results from four large-scale follow-up studies of drug treatment during the 1990s: the California Drug and Alcohol Treatment Assessment (CALDATA), Services Research Outcome Studies (SROS), and the National Treatment Improvement Evaluation Study (NTIES), and Drug Abuse Treatment Outcome Study (DATOS) (See also PIC ID Numbers 5994, 5994.1, 5994.3 and 5994.4). From before to after treatment, each study revealed across-the-board positive changes in drug use, crime, and health status. Clients in both short-term and long-term residential treatment experienced positive changes in drug use, crime, employment and health more often than clients in outpatient treatment. Clients discharged from (rather than maintained on) methadone displayed positive changes less often than any other group in treatment. Clients in the SROS showed consistently fewer changes than others on drug use, crime, employment, and health. This finding may be due to the longer period encompassed by the study and lower precision in measuring long-term patterns of change through the study's measurement of drug use, crime, employment, and health. Further studies are needed on the potential of these data to capture differences in client populations, organization of services, and clinical practices that may explain differential outcomes and costs.

AGENCY SPONSOR: Center for Substance Abuse Treatment

FEDERAL CONTACT: Smith, Ron
301-443-7730

PIC ID: 5994.2

PERFORMER: National Opinion Research Center (NORC)
Chicago, IL

The National Treatment Improvement Evaluation Study: Retention Analysis

One important mission of the Center for Substance Abuse Treatment (CSAT) is to expand the knowledge about and the availability of effective treatment and recovery services. To aid in accomplishing this mission, CSAT has made a significant commitment to developing and acquiring high-quality data about treatment of clients, the services provided for them, and outcomes. By establishing National Evaluation Data Services (NEDS), CSAT has attempted to provide a wide array of data management and scientific support services to gain evidence on which to base answers to questions about what kinds of treatment are most effective for curbing addiction-related behavior. This study uses data from the National Treatment Improvement Study (NTIES), a national evaluation of the effectiveness of substance abuse treatment services delivered in comprehensive treatment demonstration programs supported by CSAT, to analyze what service-delivery unit factors such as providing vocational training, increase the odds of program completion. The study was based on NTIES intake and treatment episode completion status data for 3,117 clients across 61 service delivery units. Results indicated that: In general, shorter programs have higher treatment episode completion rates but longer programs retain clients for longer periods; long-term residential programs exhibit higher treatment episode completion rates than long-term outpatient (non-methadone) or correctional programs; and the median length of stay for clients in long-term outpatient (non-methadone) or correctional programs with intended lengths of treatment of 120 days or more were lower than in the 90 to 119-day programs, suggesting that setting the intended length of treatment at 120 days or more may be counterproductive to retaining clients. Among the avenues suggested for further analysis was investigating why clients leave programs. (See also PIC ID#s 5994, and 5994.2 through 5994.4.)

AGENCY SPONSOR: Center for Substance Abuse Treatment

FEDERAL CONTACT: Smith, Ron
301-443-7730

PIC ID: 5994.1

PERFORMER: Battelle Corporation
Arlington, VA

In-Progress Evaluations

Mental Health Services

Evaluation of the Comprehensive Community Mental Health Services for Children and their Families Program - Phase I

The Center for Mental Health Services (CMHS) is completing an evaluation of 22 grant sites of the Comprehensive Community Mental Health Services for Children and their Families Program funded in fiscal years 1993 and 1994. Local evaluators hired at each site have gathered basic descriptive information on about 40,000 children enrolled across all of the sites. They also have obtained information on functional outcomes at four points in time including intake, six months, 12 months, and 24 months for almost 1,000 children who remain continuously in services. External evaluators visited the sites annually to assess the degree to which each site implemented services in accordance with system of care goals and philosophy. A reliable system-of-care implementation tool was developed. Preliminary results indicate that a high percentage of children improve or maintain their functional outcomes, and that collaboration with the child welfare, juvenile justice, and education sectors has increased as indicated by a higher number of referrals from these sectors over the years in the program. A study comparing three systems of care with three service delivery systems will provide empirical evidence on the effectiveness of care systems.

AGENCY SPONSOR: Center for Mental Health Services

FEDERAL CONTACT: Santiago, Rolando L., Ph.D.
301-443-3808

PIC ID: 7269

PERFORMER: Macro International, Inc.
Calverton, MD

EXPECTED DATE OF COMPLETION: 12/31/2000

Evaluation of the Comprehensive Community Mental Health Services for Children and their Families Program - Phase II

The Center for Mental Health Services (CMHS) is conducting an evaluation of 23 sites of the Comprehensive Community Mental Health Services for Children and their Families Program funded in fiscal years 1997 and 1998. Evaluators hired at each site currently gather descriptive data on such measures as demographics, functional status, diagnosis, and risk factors of enrolled children and their families as well as outcome data in such areas as social functioning, substance abuse, school performance, and juvenile justice involvement in a representative sample of 225 children. The children are assessed every 6 months for up to 36 months. A service-level substudy includes a provider survey and measures of multisector service contacts, client satisfaction, and adherence to a service plan. External evaluators visit the sites annually to assess implementation of services according to system care goals and philosophy. Three systems of care are being compared with three usual service systems to study how systems of care develop over time. Preliminary analyses indicate that 21 percent of referrals come from juvenile justice agencies, 21 percent from mental health providers, 20 percent from parents, 19 percent from schools, 9 percent from child welfare programs, and the remaining 10 percent from self or other sources.

AGENCY SPONSOR: Center for Mental Health Services

FEDERAL CONTACT: Santiago, Rolando L., Ph.D.
301-443-3808

PIC ID: 7269.1

PERFORMER: Macro International, Inc.
Calverton, MD

EXPECTED DATE OF COMPLETION: 9/29/2001

Evaluation of the Comprehensive Community Mental Health Services for Children and their Families Program - Phase III

The Center for Mental Health Services (CMHS) will begin an evaluation of 20 new sites of the Comprehensive Community Mental Health Services for Children and their Families Program funded on September 30, 1999. Evaluators hired at each site will gather descriptive data on such measures as demographics, functional status, and participation in the Child Health Insurance Program of enrolled children and their families. These evaluators also will collect outcome data in such areas as social functioning, substance abuse, school performance, and juvenile justice involvement in a representative sample of children. External evaluators will visit the sites every 18 months to assess service implementation according to system of care program goals and philosophy. Local sites will receive technical assistance on how to create logic models to describe and self-monitor the development of their systems of care. The evaluation contractor will develop an Internet-based system to enter and monitor data collected at local sites to disseminate findings through Web-based technology. The evaluation contractor will also conduct a study on the effectiveness of specific services, treatments, or supports delivered within a selected system of care site.

AGENCY SPONSOR: Center for Mental Health Services

FEDERAL CONTACT: Santiago, Rolando L., Ph.D.
301-443-3808

PIC ID: 7269.2

PERFORMER: Macro International, Inc.
Calverton, MD

EXPECTED DATE OF COMPLETION: 9/29/2003

Evaluation of the HHS Access to Community Care and Effective Services and Supports (ACCESS) Program

The ACCESS Program is a five year demonstration program that provides grants to nine States to develop integrated systems of treatment and supportive services and housing for homeless persons with serious mental illnesses. The goal of the program is to identify strategies for developing integrated service systems and to evaluate their effectiveness in providing services to homeless persons with serious mental illnesses. The evaluation of the ACCESS Program has two major components: The system-level evaluation identifies the different systems integration approaches, documents how they are implemented, and measures their impact on system capacity and system barriers. The client-level evaluation determines whether systems integration efforts result in improved service delivery, improvements in mental health and health status, rehabilitation, quality of life and permanent exit from homelessness.

AGENCY SPONSOR: Center for Mental Health Services

FEDERAL CONTACT: Frances, Randolph, Ph.D.
301-443-3706

PIC ID: 4980.1

PERFORMER: R.O.W. Sciences, Inc.
Rockville, MD

EXPECTED DATE OF COMPLETION: 7/31/2000

Substance Abuse Prevention

Cross-site Evaluation of the Community Prevention Coalitions Demonstration Grant Program

This project will conduct a cross-site evaluation of the Community Prevention Coalition (CPC) grant program over a five-year period. The goals of the evaluation are to assess: (1) the extent to which coalitions of service organizations created by the program are able to implement comprehensive and coordinated alcohol, tobacco, and other drug (ATOD) prevention programs through an expanded and non-duplicative service delivery base; (2) the extent to which coalitions are able to achieve measurable reductions in the incidence and prevalence of ATOD use, and improvements in ATOD-related social, health and safety consequences among all age, ethnic and vulnerable groups within grantee communities; (3) the contributions of various prevention strategies to site-specific outcomes and to general prevention outcomes in those sites where measurable changes are made; and (4) those characteristics common to coalitions where measurable changes are achieved, as well as those that differentiate successful coalitions from unsuccessful ones. The contractor will be required to collect process and outcome data for analysis from coalitions. In addition, data collected locally by grantees and archived community-wide indicators will be used.

AGENCY SPONSOR: Center for Substance Abuse Prevention

FEDERAL CONTACT: Kaftarian, Shakeh, Ph.D.
301-443-9136

PIC ID: 6042

PERFORMER: Cosmos Corporation
7474 Bethesda, MD

EXPECTED DATE OF COMPLETION: 5/31/2000

Evaluation of High Risk Youth Substance Abuse Prevention Initiatives Funded in 1994 and 1995

This project is designed to conduct an evaluation of the 48 High Risk Youth Substance Abuse Prevention Initiatives funded by the Center for Substance Abuse Prevention (CSAP) in 1994 and 1995, especially in regard to the following areas: (1) female adolescents, (2) high risk youth (HRY), and (3) replication of model programs for the prevention of alcohol, tobacco and other drug (ATOD) use among high risk youth. The purpose of the evaluation is to: (1) assess the impact of all programs in preventing or reducing the use of ATOD among youth at high risk for such behaviors, and (2) assess the effectiveness of specified intervention strategies in reducing the risk factors or enhancing the protective factors on which the specific programs are focused.

AGENCY SPONSOR: Center for Substance Abuse Prevention

FEDERAL CONTACT: Sambrano, Soledad, Ph.D.
301-443-9136

PIC ID: 6044

PERFORMER: EMT Associates
St. Louis, MO

EXPECTED DATE OF COMPLETION: 4/30/2000

Substance Abuse Treatment

Evaluation of Opioid Treatment Program Accreditation Project

The Center for Substance Abuse Treatment (CSAT) and other federal agencies are developing a regulatory framework for opioid substitution therapy that will change the current regulatory system for monitoring opioid treatment programs (OTPs) to an accreditation/regulatory approach. Over a five year period, CSAT will conduct and evaluate a phase-in program to obtain information that will aid in the full implementation of the new system. The goal of the evaluation is to obtain information that can guide the full national implementation of the new system for OTPs through systematic study of the processes, barriers, costs associated with a change from regulatory to an accreditation/regulatory process, and various other impacts.

AGENCY SPONSOR: Center for Substance Abuse Treatment

FEDERAL CONTACT: Diesenhaus, Herman, Ph.D.
301-443-6575

PIC ID: 6739

PERFORMER: Research Triangle Park
Research Triangle Park, NC

EXPECTED DATE OF COMPLETION: 9/29/2002

National Evaluation Data Services

The National Evaluation Data Services (NEDS) was established to increase the number of scientifically based analyses to answer vital questions in the substance abuse treatment field. NEDS represents part of an overall CSAT evaluation strategy that builds upon prior findings and seeks to mine existing data whose potential has not been fully explored. One objective of the NEDS project is to provide a wide array of data management and scientific support services across various program and evaluation activities, including an information system of available data related to the evaluation of substance abuse treatment. Another objective is to provide CSAT with a flexible analytical capability to use existing data to address policy-relevant questions about substance abuse treatment, and to clearly articulate the resulting analyses as they relate to policy through fact sheets, evaluation summaries, technical reports, methods development documents and technical guidance documents.

AGENCY SPONSOR: Center for Substance Abuse Treatment

FEDERAL CONTACT: Smith, Ron
301-443-7730

PIC ID: 5994.4

PERFORMER: Caliber Associates
Fairfax, VA

EXPECTED DATE OF COMPLETION: 9/30/2001

Persistent Effects of Treatment Studies (PETS)

The purpose of PETS is to evaluate the long-term effectiveness (up to thirty-six months) of substance abuse treatment services provided through a series of CSAT grants and cooperative agreements, and to conduct a number of special studies and policy analyses that address specific drugs of abuse, methods of treatment, populations, or policy issues. The primary follow-up studies will involve obtaining information at selected follow-up periods for persons who have completed the index treatment episode and for whom historical, intake and treatment exit data are available.

AGENCY SPONSOR: Center for Substance Abuse Treatment

FEDERAL CONTACT: Smith, Ron
301-443-7730

PIC ID: 6738

PERFORMER: Westat, Inc.
Rockville, MD

EXPECTED DATE OF COMPLETION: 9/30/2002

State Substance Abuse Managed Care Evaluation Program

The State Substance Abuse Managed Care Evaluation Project will evaluate the effects of managed care on mental health and substance abuse services in five States. Each of these five State studies will inform future behavioral health care policy.

AGENCY SPONSOR: Center for Substance Abuse Treatment

FEDERAL CONTACT: Dilonardo, Joan
301-443-8555

PIC ID: 6454

PERFORMER: Brandeis University
Waltham, MA

EXPECTED DATE OF COMPLETION: 7/31/2001

Treatment Improvement Protocols Field Evaluation

More than 25 Treatment Improvement Protocols (TIPs) have been distributed to the public. The purpose of TIPs is to transfer protocols and guidelines for the treatment of alcohol and other drug (AOD) abuse from acknowledged clinical, evaluation and administrative experts to the nation's AOD treatment field. Institution of a field evaluation is needed to: (1) assess the extent to which target audiences realize, read and implement TIPs; and (2) learn ways to strengthen the development, formatting, marketing, dissemination, use and evaluation of TIPs to ensure effective use of future Federal resources devoted to TIPs. The overall objective of the proposed evaluation is to learn the impact of TIPs on the substance abuse treatment field. The study will examine methods of dissemination used by CSAT, the success of those methods in reaching the target audiences, users' perceptions of the value of TIPs, decisions to implement TIPs, and the successes, correlates and barriers associated with implementation.

AGENCY SPONSOR: Center for Substance Abuse Treatment

FEDERAL CONTACT: Mulvey, Kevin, Ph.D.
301-443-9472

PIC ID: 6737

PERFORMER: Johnson, Bassin and Shaw, Inc.
Silver Spring, MD

EXPECTED DATE OF COMPLETION: 9/20/2001

Appendix. Evaluation Review Panel's Criteria for Assessing Program Evaluations

OVERALL SIGNIFICANCE

  • The study addresses a significant issue of policy relevance.
  • Evaluation findings are likely to be useful.

CONCEPTUAL CRITERIA

Conceptual Foundations

  • A literature review is included.
  • The project is shown to be logically based on previous findings; the report uses either theory, or models, or both.
  • The program assumptions are stated.
  • The evaluation draws from any previous evaluation.
  • The report is linked with a program and describes the program.
  • The report presents multiple perspectives.
  • Multiple relevant stakeholders are consulted and involved.
  • The timing is appropriate because the program is ready for evaluation.

Questions for Evaluation

  • The aims of the evaluation are clear, well-specified, and testable.
  • The questions are feasible, significant, linked to the program, appropriate for the resources and audience, and derive logically from the conceptual foundations.
  • The questions show ingenuity and creativity.

Findings and Interpretation

  • The conclusions are justified by the analyses.
  • The summary does not go beyond what the data will support.
  • The appropriate qualifiers are stated.
  • The conclusions fit the entire analysis.
  • Equivocal findings are handled appropriately.
  • The initial questions are answered.
  • The interpretation ties in with the conceptual foundation.
  • The report notes that the findings are either consistent with or deviate from the relevant literature.
  • The presentation is understandable.
  • The results have practical significance.
  • The extent of program implication is assessed.

Recommendations

  • The recommendations follow from findings, are worth carrying out, and are affordable, timely, feasible, useful, and appropriate.
  • The recommendations are shown to be relevant to the questions asked.
  • The breadth of specificity of the recommendations is addressed.
  • Any recommendations for either future evaluations, or improvements, or both are clearly presented.

METHODS

Evaluation Design

  • Design considerations include overall appropriateness, soundness, feasibility, funding and time constraints, generalizability, applicability for cultural diversity, assessment of the extent of program delivery, validity, feasibility for data collection, reliability of selected measurements, use of multiple measures of key concepts, and appropriateness of the sample.
  • Variables are clearly specified and fit with the questions and concepts.
  • The design permits measurement of the extent of program implementation and answering of the evaluation questions.

Data Collection

  • Data are collected using appropriate units of measurement for analysis, controls for participant selection and assignment bias, and proper handling of missing data and attrition.
  • Data collection is characterized by use of an appropriate comparison group of control; adequate sample size, response rate, and information about the sample; a data collection plan; data collection that is faithful to the plan; attention to and cooperation with the relevant community; project confidentiality; and consistency.
  • The quality of the data (including the quality of any extant data sets used in the study) and the efficiency of sampling are addressed.
  • The data collection is appropriate to evaluation questions.

Data Analysis

  • The data analysis addresses the handling of attrition, the matching of the analysis to the design, the use of appropriate statistical controls, the use of methodology and levels of measurement appropriate to the type of data, and estimation of effect size.
  • The analysis shows sensitivity to cultural categories.
  • The analysis makes appropriate generalizability of inferences.
  • The chosen analysis type is simple and efficient.

CROSS-CUTTING FACTORS

The following are cross-cutting factors that are likely to be important at all stages of a report: clarity, presentation, operation at a state-of-the-art level, appropriateness, understandability, innovation, generalizability, efficiency of approach, logical relationships, and discussion of the report's limitations. The report should also address ethical issues, possible perceptual bias, cultural diversity, and any gaps in study execution.