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Performance Improvement 2001

Publication Date
Dec 31, 2000

Foreword

Performance Improvement 2001: Evaluation Activities of the U.S. Department of Health and Human Services is the seventh 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, and strategies. It contains brief summaries of evaluation results and provides a federal agency contact name for obtaining more detailed project information.

Evaluations summarized in this report contribute to performance improvement in one or more of the following ways:

  • Program effectiveness studies provide 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.
  • 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 management reflects the need of program managers to obtain information or data helpful for effectively designing and managing a program.

Performance Improvement 2001 includes HHS evaluation projects completed and in progress during fiscal year (FY) 2000. The report is organized into three chapters. Chapter I provides the “Results in Brief” of selected program effectiveness evaluations, organized by general HHS program areas. Chapter II highlights the results from eight FY 2000 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 2000 evaluations completed and in progress by the 11 HHS agencies and the Office of the Secretary. The appendices contain a description of the HHS evaluation program (A), acknowledgments of the HHS officials who contributed to the report (B), and the HHS Evaluation Review Panel (C), a group of external evaluation expects who recommended evaluations for highlighting in Chapter II and the criteria they used to review the nominated reports.

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

Tommy G. Thompson
Secretary
U.S. Department of Health and Human Services

Chapter I - Results in Brief of Selected Program Effectiveness Evaluations

In this chapter of Performance Improvement 2001, the U.S. Department of Health and Human Services (HHS) presents the “results in brief” of FY 2000 completed evaluations that specifically address the effectiveness of a program or service. The evaluation may focus either on: (1) broad program strategies, which may encompass a number of authorized programs to address a particular need; (2) a single program that has it own congressional authorization and appropriation; or (3) a specific activity within a program that is essential to its overall effectiveness. These evaluations may provide important information for Congress in decisions about HHS programs. The evaluations are organized according to general HHS programs areas:

Public Health Programs

  • Access to Health Care
  • Drug Application and Review
  • Environmental Health
  • Food Safety and Nutrition
  • Health Statistics
  • Infectious Disease Prevention
  • Injury Prevention
  • Maternal and Child Health
  • Occupational Health
  • Public Health Infrastructure

Healthcare Financing

Human Service Programs

Welfare Reform

  • Cross-Cutting
  • State Welfare Reform Programs

The “results in brief” presentation for each evaluation provides the title of the final report, followed by a capsule summary of the HHS program involved, the study purpose, the major findings, and the recommendations or uses. Following the summary is a reference page number in Chapter III for additional information on the HHS agency sponsor, federal contact (including telephone number), the evaluation performer, and the project database number in the HHS Policy Information Center (PIC), where an electronic copy of the final report is accessible at the Internet address: http://aspe.dhhs.gov/pic.

Public Health Programs

PUBLIC HEALTH PROGRAMS

ACCESS TO HEALTH CARE

The National Health Service Corps

The evaluation of the effectiveness of the National Health Service Corps (NHSC) focused on mechanisms for training and recruiting providers, placement in underserved areas, and retainment in primary care and related professions. The findings showed that NHSC:

  • needs to focus more sharply on the loan repayment program to meet the needs of underserved populations, based on findings that the loan repayment program has greater impact in achieving NHSC objectives.
  • achieves better outcomes in rural communities, because they may enable young clinicians to make relatively important contributions in a short period, enhancing their professional gratification.
  • should strategically manage the mix of health professionals it supports in response to both community requirements and NHSC health service delivery objectives.

The study concluded that underserved areas continue to need NHSC placements if they are to provide basic health care to a growing and diverse population. NHSC helps extend and expand access to basic health care services and improves the health care delivery system in underserved communities.

DRUG APPLICATION AND REVIEW

Evaluation of Written Prescription Information Provided in Community Pharmacies: An 8-State Study

This evaluation assessed the quality of written prescription information provided voluntarily to individuals receiving new prescription medicines in community pharmacies. The study tested whether fictitious patients as observers were given any written prescription information by pharmacists whom they asked for drugs prescribed (in addition to the labels and stickers on their medication containers). The quality of written information was also assessed. This pilot study produced encouraging results for consumers:

  • nearly 87% of new prescriptions were dispensed with some written prescription information in addition to the label and stickers on the medication container, suggesting that the provision of written prescription information is becoming a routine practice in community pharmacies.
  • expert panelists found that most written information sheets were accurate and unbiased in content and tone. They included necessary details for monitoring and interpreting adverse reactions and appeared legible and comprehensible to consumers.

The study raised several concerns: most patient information was rated low on identifying precautions, their significance, and how to avoid them, and storage instructions and general information. The study will be repeated nationally in 2001 and the results will be used to identify areas for improvement in consumer communication of prescription information.

* * * * * *

FY 2000 Performance Report to Congress for the Prescription Drug User Fee Act of 1992

The Prescription Drug User Fee Act (PDUFA) authorized FDA to collect fees from companies that produce human drug and biological products. The PDUFA annual performance report to Congress for FY 2000 focuses on the Agency's performance toward the agreed-upon numeric goals for reviewing and acting on submissions and responding to sponsors' pre-submission requests. The major accomplishments to report are:

  • FDA continued to exceed nearly all the review performance goals in FY 2000—increasing numbers of applications filed; higher quality applications; quicker approvals for products with the requisite data; and outcomes that result in more quality products reaching American practitioners and consumers faster.
  • application filings and quality remain high by historic standards and approval times continue to drop;
  • compared to the approval rates for all new drug applications, there is a smaller increase in approval rates for new molecular entities (NMEs), unique new drugs that are approved for the first time by FDA.
  • median total approval time (i.e., time from the initial submission of a marketing application to the issuance of an approval letter) for priority applications submitted in FY 99 was 6 months, less than half the median approval times for priority applications submitted in the early PDUFA years.

The FDA performance report states that since the passage of PDUFA there has been a shift in the pattern of NME introductions with more American patients now receiving the benefits of important new drugs before they are available to citizens of other countries. This shift requires that FDA be increasingly vigilant in its post-market surveillance efforts.

* * * * * *

Infant Immunization with Acellular Pertussis Vaccines in the US: Assessment of the First Two Years’ Data from the Vaccine Adverse Events Reporting System (VAERS)

The evaluation objective was to assess the safety of infant immunization with acellular pertussis vaccines in the United States. In 1996, the FDA approved the first acellular pertussis vaccine for use in infants in the United States. The study examined adverse events in the US after infant immunization with pertussis-containing vaccines, using the Vaccine Adverse Event Reporting System (VAERS), a national surveillance system. The overall findings showed that:

  • the annual number of reported events categorized as nonfatal serious (defined as events involving initial hospitalization, prolongation of hospitalization, life-threatening illness, or permanent disability) to VAERS for all pertussis-containing vaccines declined between 1995 and 1998.
  • the annual number of less serious reports to VAERS for pertussis-containing vaccines also declined.
  • this evaluation did not identify any new safety concerns of the vaccine based on an analysis of VAERS data for acellular pertussis vaccines, with regards to adverse events identified in a 1991 Institute of Medicine report on the safety of diphtheria-tetanus-pertussis vaccine.

The study findings support the safety of marketed acellular pertussis vaccines. In addition, the VAERS data, although subject to the limitations of passive surveillance, support the prelicensure data with regard to the safety of the US-licensed acellular pertussis vaccines evaluated in this study.

FOOD SAFETY AND NUTRITION

Consumer Attitudes Toward Potential Changes in Food Standards of Identity

As part of the 1995Regulatory Reinvention Initiative, FDA evaluated federal food standards of identity regulations (intended to assist consumers with the identity, quality, and fill of containers for standardized foods) to guide policy decisions about which standards should be retained, revised, or revoked. Consumer attitude data toward standards of identity regulations, collected in eight focus group discussions with household grocery shoppers, were analyzed. The principal findings showed that the focus group participants:

  • those who think standards are bad believe that truth-in-labeling laws are adequate protection for consumers;
  • supported standards in a philosophical sense;
  • did not think their choices were being unduly restricted by standards;
  • had concerns about the time it takes them to find products they like in the grocery store than about a lack of product choice.

Overall, the focus group participants were wary of trying to draw generalizations about when standards would be bad, and instead, they felt that evaluating and revising standards could only be done on a case-by-case basis. Furthermore, participants felt that FDA should get input from consumers about standards and not rely on industry.

* * * * * *

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

This evaluation study analyzed data to determine the status of food labels three years after nutrition labeling rules were implemented in 1994. FDA conducted the 1997 Food Labels and Package Survey (FLAPS) as an ongoing effort to monitor the food industry’s response to the food labeling regulations. FLAPS allows FDA to characterize various aspects of the labeling of processed, packaged food products, including the prevalence and accuracy of nutrition labeling, health claims, and nutrient content claims. Product classes representing 80 percent of the sales in each of 58 product groups were included in the sample. From each product class, FDA selected the 3 top- selling product brans and randomly selected follower brands. Based on label information from a final sample of 1,267 food products and weighting by food market data, FDA determined the percentage of products sold that bearNutrition Fact labels, health claims, and nutrient content claims. The major findings of the survey were that:

  • Nutrition-labeled products accounted for an estimated 96.5 percent of the annual sales of processed, packaged foods.
  • An additional 3.4 percent of products sold were exempt from labeling regulations.
  • Nutrient content claims and health claims appeared on a estimated 39 percent, and 4 percent respectfully, of the products sold.

The 1997 FLAPS collected sufficient product label information to estimate the prevalence of nutrition labels for most processed, packaged foods in the US. Although regulation for nutrition labeling have changed since the survey’s start in 1976, the FLAPS data collected allow for analysis of consistent patterns and trends in food labeling practices.

HEALTH STATISTICS

Report of the Panel to Evaluate the U.S. Standard Certificates and Reports

TheNational Vital Statistics System is the Nation’s capacity to collect data maintain statistics on birth, deaths, fetal deaths, marriages, and divorces. These data come from State vital registration systems where standardize certificates are filed. The evaluation purpose was to assess current certificates for usefulness and quality for statistical and legal purposes; identify unmet data needs and determine whether the standard certificates should be changed; make recommendations for a standard vital statistics data base. Based on survey data from State vital registration and statistics executives and representative national health organizations and the work of an expert panel, the study found that:

  • substantial changes were needed for the standard birth certificate, particularly the medical portion;
  • additional data items are needed on the mother’s health which could linked to other health data sources;
  • changes are recommended for the standard certificates on death and fetal deaths to include data items that could permit linkages to other health data systems and would improve the quality of “cause-of-death” data.

INFECTIOUS DISEASE PREVENTION

Evaluation of 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. To address the problem CDC developed prevention guidelines in collaboration with the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) and published the guidelines in the Morbidity and Mortality Weekly Report in 1996. This evaluation assessed the management of GBS disease in the United States, looking at the extent to which the guidelines were followed and factors associated with poor compliance. Results showed that:

  • implementation of the new GBS prevention guidelines was successful at the test site (Group Health Cooperative of Puget Sound) and was accomplished in a short time period;
  • more complete compliance with GBS guidelines helped to improve clinical outcomes for mothers with GBS infections; and
  • a cost benefit analysis showed that the costs of delivering antibiotics is minimal compared with the potential health and economic benefits from reduced infant mortality.

This population-based evaluation is a good example of collaboration between managed care organizations and public health agencies to determine the impact of national disease prevention guidelines on health care providers.

INJURY PREVENTION

Evaluation of National Center for Injury Prevention and Control (NCIPC) Injury Control Recommendations for Bicycle Helmets

In 1995, NCIPC published recommendations on the use of bicycle helmets in preventing head injuries, including information on the magnitude of related head injuries, potential impact of increased helmet use, helmet standards and crash performance, barriers to increased helmet use by the public, and approaches to increase community-level bicycle helmet use. The evaluation purpose was to measure effective use of the recommendations by NCIPC’s injury prevention constituents (state and local health officials and national bicycle safety advocate organizations) and access the process of developing the recommendations. The study’s survey of constituents showed that:

  • ninety percent of respondents found the recommendations useful for their efforts to increase bicycle helmet use, such as directing a bicycle helmet promotion program, advocating for a injury prevention program, and disseminating information to other injury prevention constituents; and
  • eighty percent of respondents said that CDC should develop additional recommendations to address prevention service problems.

The evaluative survey results on bicycle helmets have helped CDC to improve the development and dissemination of injury control recommendations.

MATERNAL AND CHILD HEALTH

Effect of Healthy Start on Infant Mortality and Birth Outcomes

TheHealthy 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 some of the areas with the highest infant mortality rates in the country. Strategies used in the selected fifteen high-risk communities included outreach, case management, public information campaigns, support services, health education, and enhanced clinical services. Thirteen of the fifteen sites were urban. This evaluation analyzed the effects ofHealthy Start on pregnancy- related outcomes by comparing the original fifteenHealthy Start sites with comparison communities from 1991 thorough 1996. Infant mortality related outcomes – prenatal care utilization, pre-term birth rate, incidence of low and very low birth weight infants, and infant mortality rates–for the fifteenHealthy Start communities were compared with two comparison communities pre site for fourteen of the sites. Conclusions of the study suggest thatHealthy Start communities showed:

  • increased use of any prenatal care in five project sites;
  • increases in first trimester care in three communities;
  • improved adequacy of prenatal care in eight communities;
  • increases in the adequacy of prenatal care in four projects;
  • improved adequacy of the number of prenatal care visits in nine projects; and
  • and improvements in all prenatal care measures in three of the project areas.

As for health outcomes, Healthy Start was associated with lower pre-term births in four sites; reductions in low birth weight in three project areas; and reductions in infant mortality rates, neonatal mortality, and post neonatal mortality in two sites each.

PUBLIC HEALTH INFRASTRUCTURE

Evaluation of the National Electronic Telecommunication System for Surveillance

The National Telecommunications System for Surveillance (NETSS) is a computerized public health surveillance system that assembles, analyzes and disseminates weekly data on about 50 nationally notifiable diseases, provided by state and territorial health agencies and transmitted to CDC's Epidemiology Program Office (EPO). Providers, clinical laboratories, and public health officials collect NETSS data at the state and local level. The evaluation purpose was to examine the effective use of communicable disease data transmitted to CDC over NETSS by state and local public health officials, as well as CDC officials. Identification of barriers to effective use and ways to make improvements was and another study objective. The results showed that:

  • state health officials said they are making effective use of NETSS data to track trends in communicable diseases, detect epidemiological patterns, and compare observed levels of disease to expected levels;
  • these officials had encountered some technical barriers to the use of NETSS data; and
  • some major problems identified concerned outdated computer technology or incompatibilities with other electronic disease surveillance systems, including unresolved software malfunctions.

The state epidemiologists recommended that disease data from other states be available for analysis.

Healthcare Financing

HEALTHCARE FINANCING

Report to the President: Prescription Drug coverage, Spending, Utilization, and Prices.

Although the use of prescription drugs are increasingly improving health outcomes and quality of life, these drugs, and in particular new drugs, are not available to everyone. The elderly and disabled Medicare beneficiaries in particular have either inadequate or no coverage for drugs. The purpose of this study is to examine drug costs and trends for Medicare beneficiaries, using a combination of public and private databases, data on coverage, effects of coverage on spending and utilization, and prescription drug prices. The principal findings are:

  • although 85% of Medicare beneficiaries use at least one prescription drug annually, only 54% were covered for a full year during 1996, and 25% had no coverage. Most sources of drug coverage for these individuals are unstable; and drug benefits are becoming less generous.
  • the very old, those who live outside a metropolitan area, and those at the higher end of the poverty spectrum are the least likely to be covered.
  • rates for prescriptions are currently higher for those with five or more chronic conditions.
  • there are very significant differences in drug utilization and out-of-pocket spending between those with coverage and those without, regardless of health status.
  • prescription drugs represent a significant source of spending, taking up about one-sixth of all health spending by the elderly (cash customers pay more for drugs than do those with third party payments).

The study provides a detailed examination of multiple factors related to coverage, utilization, and spending for prescription drugs, particularly for the Medicare population.

Human Service Programs

HUMAN SERVICE PROGRAMS

The Potential of the Child Support Enforcement Programs to Avoid Costs to Public Programs: A Review and Synthesis of the Literature

The Child Support Enforcement Programs ensures that non-custodial parents provide appropriate financial support for their children through four major services: locating absent parents, establishing paternity, establishing child support and medical support obligations, and enforcing support orders. One of the goals of the program is to reduce government expenditures on means-tested public assistance programs by increasing the amount of child support paid to custodial households by non- custodial parents. This study synthesizes the theoretical and empirical literature on cost avoidance to build a comprehensive and coherent framework to evaluate the intricacies of child support cost avoidance. The main findings drawn from the literature are:

  • several studies present estimates of cost avoidance, but differences in methodology, populations analyzed and assumptions by the authors make comparability and generalizations difficult to estimate;
  • although realized cost avoidance is relatively modest under the current child support enforcement system, the potential for cost avoidance is unknown;
  • evaluations of several demonstrations found that periodic review and updating of support orders for AFDC cases was effective in avoiding state and federal government costs, that is the overall cost of the process was less than the increase in dollars collected; the literature indicates that child support enforcement has, at most, a limited indirect effect on cost avoidance by changing the marital and childbearing behavior of custodial and noncustodial parents.

The current research focuses on custodial parents and suggests that child support enforcement has a small deterrent effect on divorce and little or no deterrent on out-of-wedlock childbearing. The few published studies on the effect of child support on the labor force participation of custodial mothers find mixed results.

* * * * * *

Evaluation of Head Start Family Child Care Demonstration: Final Report

This evaluation assessed, over a three-year period, the effectiveness of the Head Start Family Child Care Homes (HSFCCH) demonstration projects, funded by the Administration for Children, Youth, and Families (ACYF) during Fiscal Year 1992. It also compares services delivered in family child care homes to those delivered in Head Start centers. The findings showed: on

  • no significant differences in child cognitive, physical, and social-emotional outcomes between family child care homes and center classrooms;
  • the kindergarten followup did not show any significant differences as a result of the family child care homes versus center classroom;

The study concluded that family child care homes can meet Head Start standards of quality and can produce similar outcomes in children and families.

Welfare Reform

WELFARE REFORM

CROSSCUTTING PROGRAMS

Welfare Leavers and Medicaid Dynamics: Five States in 1995

State welfare caseloads have been declining at an unprecedented rate since 1994, partly as a result of state and federal welfare reform efforts and partly because of a strong economy. Medicaid enrollment for children and their parents has been shrinking as well (although less so than welfare), in spite of state efforts to expand their Medicaid eligibility policies. This study analyzed the 1995 Medicaid enrollment patterns of children and their parents in five states--Alabama, California, Florida, Michigan and New Jersey--to assess the impact of welfare declines on overall Medicaid enrollment. The findings showed that:

  • declines in the welfare caseload which began in 1995 are likely to have a noticeable effect on state Medicaid programs, in terms of overall enrollment, caseload mix, and per capita expenditure levels.
  • some of the states were able to increase enrollment through the non-welfare eligibility groups by making greater use of the child poverty-related, transitional assistance, and medically needy groups.
  • many welfare leavers are not staying on Medicaid and are at risk of becoming uninsured.
  • states are experiencing considerable turnover in their Medicaid caseloads.
  • since state welfare caseloads declined at much greater rates after 1995, there is concern that Medicaid enrollment will drop even more, and that Medicaid reductions may be contributing to the continuing problem of the uninsured.
  • state officials report that many families leave welfare without providing the information needed to redetermine their continued eligibility for Medicaid.

One conclusion of the study is that while states may continue to make policy changes to expand Medicaid coverage provisions in an effort to reduce the number of uninsured, these changes are not likely to be effective unless steps are also taken to improve individual continuity in Medicaid coverage.

* * * * * *

Dynamics of Children’s Movement Among the AFDC, Medicaid, and Foster Care Programs Prior to Welfare Reform: 1995-1996

This study examined patterns of program utilization by children before and after welfare reform to assess how the social safety net programs and human service utilization have been affected by ending the entitlement to cash assistance and placing new work-related requirements on their parents. Three programs affected by welfare reform were studied: Temporary Assistance for Needy Families (TANF), Medicaid, and foster care during 1995-1996, or the years immediately prior to welfare reform, which was implemented first in 1997. The major findings were:

  • the consistency across states in the numbers participating in AFDC and Medicaid prior to foster care entry suggests that poverty, or perhaps participation in welfare program, plays an important role in the entry of children into foster care.
  • transitions from AFDC to a system exit are most likely among the oldest children in all three states, suggesting that families with the youngest children are the most acutely needy and likely to remain on AFDC longer than families with older children.
  • With the emphasis on work and time limits, welfare reform is likely to result in more and earlier exits from cash assistance.

The major conclusions of the study are that welfare reform is likely to have many effects on children and their families. Each state will differ based on its program practice and policies, economy, demographic characteristics and other factors. Each state will have to tailor its plans accordingly.

* * * * * *

STATE WELFARE REFORM PROGRAMS

Final Results from Florida’s Family Transition

In 1994, Florida started the Family Transition Program (FTP) in Escambia Country as a pilot test site, the first welfare reform initiative to test time limits for eligibility and continued benefits. Families were limited to only 24 months of assistance during a 60-month period (36 months out of 72 for the least job-ready persons) and were provided services and incentives to find work. The evaluation was a random assignment comparison group study of welfare recipients placed in FTP and others receiving traditional Aid to Families with Dependent Children (AFDC) benefits. The findings showed that:

  • FTP recipients, compared to those in the AFDC group spent less time on welfare over the four follow-up periods. There were fewer impacts on children, with the exception of some negative impacts on adolescents’ school performance; and
  • FTP families gained in income more than they lost in welfare payments. Slightly less than half of the FTP families who reached their time limits worked steadily in the subsequent18 months, many relying on family, friends, Food Stamps, and housing assistance.

The conclusion was that time limits can be imposed without widespread impact on families, but that the robustness of the local economy may be a strong contributing factor.

* * * * * *

Reforming Welfare and Rewarding Work: Final Report on the Minnesota Family Investment Program (Summary; Volume I: Impact on Adults; Volume II: Impact on Children)

The Minnesota Family Investment Programs (MFIP) combined financial work incentives with participation or work requirements for long-term welfare recipients. The MFIP evaluation examined ways that states could increase the probability that long-term welfare recipients will be able to support themselves before they reach their time limit on welfare benefits; how states support the efforts of low-income workers to stay in their jobs and provide for their families in this era of time-limited welfare; how social policies avoid penalizing marriage; and the policy adjustments that states have made in changing their welfare systems from Aid to Families with Dependent Children (AFDC) to Temporary Assistance to Needy Families (TANF) affect families and children. The evaluation findings show that:

  • single-parent, long-term welfare recipients benefitted most from the MFIP program, mainly in employment and increased earnings compared to AFDC participants. However, total costs were higher, since families retained their welfare benefits even as their earnings increased.
  • MFIP families showed improvements in family well-being, as evidenced by positive parental reports on children’s behavior, decreases in reported domestic abuse, and modest increases in marriage rates.
  • For two-parent recipient families, the proportion of parents who stayed married increased, compared to AFDC families, and the program enabled second earners to work less.
  • Results on parent or child outcomes between the experimental and control groups were not significantly different for more recent welfare applicants for whom job preparation services were not mandatory.

Lessons learned from this evaluation concern types of families for which the experiment is most effective (e.g., single-parent and two-parent long-term recipients versus single parent and two-parent recent applicants); which program components (financial incentives, mandatory employment and training) contribute most to economic outcomes and social impacts on both families and children.

* * * * * *

Evaluation of North Dakota’s Training, Education, Employment, and Management (TEEM) Program

The North Dakota Training, Education, Employment and Management (TEEM) program is the state’s Temporary Assistance to Needy Families (TANF) program to families, providing the following cash assistance and supportive services: a computerized assessment that results in a social contract and referrals to needed services; incentives to promote work and work effort; sanctions for non-compliance with the program requirements; increased asset limits allowing families to save while on aid; and a benefit cap that precludes TEEM recipients who get pregnant while on aid from receiving additional cash benefits for that child. The evaluation of TEEM monitored program implementation and examined client caseload trends and client characteristics between 1997 and 1999 to measure outcomes. The monitoring effort identified programs improvements needed in providing information to recipients on Earned Income tax Credit, more training for TEEM staff on case manager role; and changes in the client assessment process. The client outcome trend data showed that:

  • TEEM families retained substantial public assistance from other sources after finding employment;
  • Native Americans increased as the proportion of TEEM adults cases between 1998-1999 and had higher TEEM recidivism rates;
  • the child-only cases increased proportionately and were living with parents receiving disability payments;
  • and the proportion of case closures due to employment declined over time, which may have been due to problems with the closure codes.

* * * * * *

Analysis of Administrative Data on Families Receiving Welfare and Diversion Assistance under the Work First Program: Third Quarterly Report

TheNorth Carolina Work First Program’s third quarterly report analyzing administrative data examined patterns of welfare participation, employment, earnings, and other key outcomes among families who enter and leave theWork First program, and persons who receive Diversion Assistance. The findings show that:

  • families in the AFDC entry cohort were more likely to be still on assistance 36 months after going on welfare compared to families in the Work First entry cohort;
  • Work First program has had far less impact on child-only cases than on other cases;
  • length of stay on welfare for all entry cohorts was longer for persons without a work history, persons without a work history and a high school diploma, families that were younger, African American, and living in large cities; and
  • fewer families in theWork First program, compared to the AFDC exit cohorts returned to cash assistance in the followup study period.

No major differences were found between the exit cohorts in employment rates, which seemed to be more influenced by seasonal factors. All cohorts showed evidence of earning progression after leaving welfare, controlling for seasonal variations.

* * * * * *

Study of Families Receiving Diversion Assistance Payments Under the Work First Program

TheNorth Carolina Work First Diversion Assistance program serves families eligible forWork First cash assistance but instead receive diversion assistance in the form of cash payments equal to as much as three months ofWork First benefits. The program goal is to provide assistance to families when they need short-term help to become or remain self-sufficient, as an alternative to going on welfare. The evaluation consists of telephone interviews with 242 families receiving assistance between May 1999 and August 1999. The study found that:

  • client household characteristics, plus prior welfare use and employment, varied by county which was interpreted as variations in the county’s approach to targeting diversion assistance.
  • one quarter of respondents said they were not working;
  • there was evidence of food deprivation among 22 percent of respondents but no evidence of major problems of hunger, homelessness, poor housing conditions, or placement of children.

The results suggest that county administration of the programs should take caution in using diversion for applicants that do not have a recent work experience.

* * * * * *

Study of Families Leaving Work First Due to Time Limits: Results of the Second Round of Follow-up Surveys

The evaluation of theNorth Carolina Work First program includes a report on results of the second round of follow-up surveys in late 1999 on the status of families who left the programs in August 1998 as a result of reaching the 24-month time limit. The first round of surveys were conducted between December 1998 and March 1999. Between the first and second survey rounds, the employment changes experienced by leaving families showed that:

  • employment was slightly higher; the rates of job turnover were not significant; almost half of respondents said they received a raise between interviews (however, the earning progress ion may be unique to the sample and all welfare leavers).
  • as for employer health insurance, participation in such plan when available increased for respondents, but largely because they became eligible to participate in plans by reason of increase time on the job and increased work hours;
  • the two reasons given by respondents who were unemployed at the second round were-- could not find a job or get one after applying, and could not take work because of disability or illness.
  • There was an increase in the number of respondents who said they had experienced adverse events since leaving, with ability to buy food as the one most often mentioned.
  • No significant differences were found for access to health care, child care, and housing, nor differences in children’s school performance.
  • Employed respondents with higher incomes thought they were better off without welfare, but the pattern was inconsistent at the lower income levels.

Chapter II - Highlights of Outstanding Evaluations Completed During Fiscal Year 2000

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) 2000. Included are summaries of eight evaluation projects selected by the HHS Evaluation Review Panel, a group of outside evaluation experts. The Panel reviewed a total of 29 reports nominated by HHS agencies and selected these eights reports 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 C.

The eight studies are organized under two headings:program effectiveness evaluations andenvironmental assessments. These headings represent two common uses of HHS evaluation resources.Program effectiveness evaluationprovides a way to determine the impact of the Department’s 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

PROGRAM EFFECTIVENESS

Reforming Welfare and Rewarding Work: Final Report on the Minnesota FamilyInvestment Program (MFIP).

Summary
Volume I: Impact on Adults
Volume II: Impact on Children

Highlights:

This final report on an experimental program in Minnesota that combined financial incentives to work with participation or work requirements for long-term welfare recipients provides insight into four major policy issues. The issues addressed were the following:

  • How can states increase the probability that long-term welfare recipients have a way to support themselves before they reach their time limit on welfare benefits?
  • How should policy makers support the efforts of low-income workers to stay in their jobs and provide for their families in this era of time-limited welfare?
  • How can social policies avoid penalizing marriage?
  • How do the policy changes that states have made in moving their welfare systems from Aid to Families with Dependent Children (AFDC) to Temporary Assistance to Needy Families (TANF) affect families and children?

The evaluation, conducted from April 1994 and March 1996, utilized a random assignment research design to evaluate the MFIP success. More than 14,000 families in seven Minnesota counties were assigned to either the MFIP program or to the traditional AFDC program. The two groups were compared on employment, welfare receipt, and outcome measures related to family life, child well-being and other factors of interest.

Findings indicate single-parent, long-term welfare recipients benefitted most from the MFIP program as evidenced by increases in employment and earnings compared to AFDC participants. However, total costs were higher, since families retained their welfare benefits even as their earnings increased. MFIP families showed improvements in family well-being, as evidenced by parental reports on children’s behavior, a decrease in reported domestic abuse, and a modest increase in marriage rates. For two-parent recipient families, there was an increase in the proportion of parents who stayed married, compared to AFDC, and the program enabled second earners to work less. Results were mixed for recent welfare applicants.

Purpose

This evaluation was designed to assess the costs and benefits of the MFIP project, a program designed to encourage work and reduce dependence on welfare, while simultaneously reducing poverty. Under the rules of the MFIP, recipients of welfare remained eligible for assistance until their income reached 140 percent of the poverty line. Child care costs for working parents were paid directly to child care providers, eliminating the need for a parent to pay for child care up front. In addition, the rules and procedures related to obtaining welfare benefits were simplified.

Background

A new vision of welfare that encourages “making work pay” for low-income families while reducing their dependence on public assistance has emerged over the past decade. This philosophy is embodied in the Personal Responsibility and Work Opportunities Reconciliation Act (PRWORA), which was enacted in 1996. Traditional welfare programs tend to provide disincentives for single mothers to enter the workplace, as benefits are often better than the income that could be obtained. Two-parent families are required to meet stringent eligibility rules that tend to discourage marriage. At the same time poverty rates for families with children in the U.S. have increased since the mid- 1970s. To meet the requirements of the Personal Responsibility and Work Opportunities Reconciliation Act (PRWORA), states have attempted to make work pay by ensuring the transition to work does not result in a decline into poverty

The MFIP program, which was implemented prior to the passage of the PRWORA, demonstrates the results of implementing two complementary policies that previously have been implemented as single approaches: financial incentives that reward work and reduce poverty, and for long-term welfare recipients, mandatory participation in employment-focused services to reduce long-term welfare dependence.

The MFIP program was first implemented as a field trial in April 1994 in three urban and four rural counties in Minnesota. An interim evaluation of the project was provided in 1997. This final evaluation, presented in two volumes and a summary report, covers the period from 1994 through 1998.

Methods

The evaluation design had two components, one directed primarily at the welfare recipients and the other examining the specific effects on children. Between April 1994 and March 1996 over 14,000 families were assigned, using a lottery approach, to the MFIP group or to the traditional AFDC program. A sub-sample of single-mother families with preschool and school-age children who entered the evaluation between April and October 1997 were selected to provide information on impacts of the program on children. MFIP differed from AFDC in three key ways: while in both MFIP and AFDC welfare benefits decreased as earned income rose, the working families in MFIP were allowed to keep more of their monthly financial benefits and to continue to receive these benefits over a longer period of time. Child-care expenses were paid directly to providers, leaving no up-front costs for the parent. MRIP required long-term welfare recipients to participate in employment and training services, while participation in training programs was voluntary under the AFDC program. The MFIP program combined AFDC, Minnesota’s Family General Assistance and Food Stamps into a single monthly payment. In addition, the program rules were simplified, particularly for two-parent families.

There were two sub-groups of MFIP recipients in both the single and two-parent families; those considered long-term welfare recipients (mothers on welfare at least 24 of 36 months prior to random assignment) and recent applicants. Recent applicants were not required to participate in the mandatory employment aspects of the program.

The effects of MFIP were evaluated by comparing outcomes for families randomly assigned to MFIP with outcomes for families randomly assigned to the AFDC system. For the subsample, data on family and child well-being were collected from a survey administered to the families three years after they entered the program. The survey collected information on child and family well-being, including family employment and income; parents’ psychological well-being and parenting practices; and children’s health, behavior and school progress. Data were also collected from administrative case records.

Findings

Throughout the 3 year period following their assignment, single-parent long-term recipients (SPLTR) on MFIP had increased employment rates and increased average earnings. These effects were smaller in the rural counties. MFIP increased the number of SPLTR on welfare, but reduced the number relying solely on welfare. MFIP increased incomes and reduced measured poverty. SPLTR MFIP recipients were more likely to be married than AFDC recipients at the end of the 3 year period.

Single parent, recent applicants (SPRA) on MFIP demonstrated modestly increased employment but not increased earnings during the same 3 year period. MFIP actually increased the number of SPRA on welfare, but reduced the number relying solely on welfare. Two-parent long-term recipients (TPLTR ) were less likely than AFDC families to have both parents working, leading to lower family earnings. While MFIP increased the proportion of TPLTR receiving welfare benefits, program participants also showed increased marital stability, income, and home ownership. MFIP had little effect on employment, earnings, or income for two-parent recent applicants (TPRA) families.

For both SPLTR and SPRA the MFIP financial incentives increased employment and earnings, but they also caused some working parents to reduce their hours. Increases in income resulting from financial incentives were responsible for antipoverty effects. The program cost more per family per year than did the AFDC system, because of this increased support for working families.

Compared to financial incentives alone, the complete MFIP program increased full-time work and earnings. SPLTR in the sub-sample also reported improvements in child-well being and declines in domestic abuse. Their children exhibited fewer behavioral problems and did better in school than children of mothers on AFDC. Children were also more likely to be placed in child care, particularly in child care centers, and were more likely to have continuous health coverage. The mothers were more likely to work and had higher incomes. Mothers of these children were also more likely to marry and less likely to experience domestic abuse than recent applicants.

Findings for children of more recent applicants (for whom job preparation services were not mandatory) reported had similar levels of behavioral problems and school progress for their children compared to children of AFDC mothers. Their children were more likely to have had continuous health coverage. The mothers were only slightly more likely to work, did not have higher incomes, and experienced few other changes in their well-being compared to AFDC participants.

In summary, MFIP has been most efficient for SPLTR, the group that is the largest and that was the major target for the program.

Use of Results

The evaluation addresses three goals that have emerged as high priorities under PRWORA: ensuring that long-term welfare recipients make substantial strides toward self-sufficiency before realizing their time limit on welfare receipt, supporting the efforts of low-income workers to advances in their jobs while providing adequately for their families, and assuring that social policies do not discourage marriage. Lessons learned from this evaluation provide important information on types of families for which this approach is most effective; which components of the program; financial incentives, mandatory employment and training B contribute to the effects; and the non-economic effects on both families and children;

AGENCY SPONSOR: Office of Planning, Research and Evaluation and the Office of Child Support Enforcement at the Administration for Children and Families (ACF)

FEDERAL CONTACT: Lawrence Wolf

PHONE NUMBER: 202-401-5084

PIC ID: 6824

PERFORMER ORGANIZATION: Manpower Demonstration Research Corporation,
New York, NY

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The Outcome of Outcomes Research at AHCPR: Final Report

Highlights

This report was prepared for use in discussions of strategic directions for the Outcomes and Effectiveness Research (OER) program at AHCPR, now the Agency for Healthcare Research and Quality (AHRQ). It covers three topics: 1) a conceptual framework for understanding and communicating the impact of OER on health 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. It examines issues of how the OER program at AHCPR can most effectively advance the field of health services research (HSR), fulfill its unique role in HSR, contribute to public health, and address the expectations of policymakers and stakeholders. Research findings in OER were classified according to four levels of impact: 1) findings that contribute to an area’s knowledge base and help focus subsequent research (e.g., new analytic methods), 2) research that prompts creation of a new policy or program (e.g., incorporating medical guidelines into practice), 3) a change in what clinicians and patients do, and 4) actual changes in health outcomes.

Conclusions and future directions identified based on these findings suggest that OER must move beyond hypothesis testing and unchannelled intellectual explorations to address knowledge gaps and address areas of application. It suggests that OER should leverage resources through partnerships with HCFA and other public and private organizations, moving from a tool using-culture to a problem-solving culture. Also, OER should develop and refine the “conceptual infrastructure” for conducting effectiveness trials, building on the effectiveness initiatives and PORTS of the 1980s. The study also identifies a need for AHCPR to develop a “dedicated knowledge transfer function” to help engage policymakers and other stakeholders in understanding the links between basic research and clinical practice.

Purpose

This report is intended both for use within the Agency for Health Care Policy and Research (AHCPR) to guide internal discussions, and for external researchers involved in outcomes and effectiveness research (OER). The key question addressed by the report is how the OER program at AHCPR can most effectively advance the field of health services research, contribute to public health, and address the expectations of policymakers and stakeholders. Through a review of accomplishments within the agency, the report provides lessons learned and recommendations for improvement.

Background

Since program inception in 1989, the AHCPR has had the primary responsibility for implementing theEffectiveness Initiative. The theoretical model underlying effectiveness research in health care is that the retrospective study of patterns of care leads to the definition of optimal treatments; this in turn could lead to substantial economic savings in the subsequent delivery of health care. AHCPR was established as an embodiment of this hypothesis that guidance for optimal medical practice can be obtained from analysis of data that is routinely gathered in the process of delivering and paying for patient care. The intent of this report is to review the evidence that this is a valid approach.

Methods

The study is based on a review of articles from grants, original concept papers for launching the “outcomes movement” and critiques of the same, analysis of private sector involvement in OER, a survey of Principal Investigators (PIs) and interviews with selected PIs, interviews with a former the Director of the Center for Outcomes and Effectiveness Research (COER), discussions with the COER staff, and recommendations made by investigators and stakeholders at two expert panel meetings. The PI survey was based on the premise that researchers should have a clear understanding of the impact of their own research. It achieved a 64% responserate, including 61 of 95 PIs.

The impact of AHCPR OER research was categorized into four levels: (1) findings that contribute to a change in practice or policy by adding knowledge or helping to focus subsequent research; (2) research findings that are incorporated into the creation of a new policy or program; (3) an actual change in what clinicians or patients do; and (4) a change in a health outcome. The first item is essentially descriptive research focused on descriptions of what occurs in the health area and in developing tools for measuring costs of care and patient reported outcomes, and identifying topics for future research.

Findings

Results suggest that PIs have been most successful in providing descriptions of what actually occurs in health care, developing tools for measuring costs and outcomes, and identifying topics for future research. Other study findings include evidence that OER has increased recognition in the medical community that evidence, not opinion, should guide clinical decision-making; acceptance that a broader range of patient outcomes needs to be measured to understand the benefits of interventions; and the perspective that research priorities should be guided in part by public health needs. The study also found that the most concrete accomplishments in 10-15 years of OER are the tools and methods developed.

Use of Evaluation Results

Although it is increasingly evident that observational designs, such as those that predominate at OER, cannot provide definitive answers regarding clinical effectiveness, these studies do produce information about benefits, risks and costs of health care. Change is dependent upon use of the information by decision makers. Suggested options to enhance the positive impact of the research include:

  • setting research priorities based on likelihood of impact;
  • increasing emphasis on problem-solving by requiring the incorporation of strategies for change as part of the study design;
  • promoting improvement in strategies and methods used to study comparative clinical effectiveness and cost effectiveness;
  • promoting development and use of practical, patient-oriented outcome measures in routine clinical practice;
  • identifying research findings that should be implemented and provide assistance to change agents; and
  • creating a mechanism to document changes in practice that may be related to AHCPR work.

AGENCY SPONSOR: The Center for Outcomes Effectiveness Research at the Agency for Healthcare Research and Quality (AHRQ),

FEDERAL CONTACT: Carolyn M. Clancy

PHONE NUMBER: 301-594-1485

PIC ID: 5979

PERFORMER ORGANIZATION: The Lewin Group, Fairfax VA

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Infant Immunization with Acellular Pertussis Vaccines in the United States: Assessment of the first Two Years’ Data From the Vaccine Adverse Event Reporting System (VAERS)

Highlights

The safety of the new acellular pertussis vaccines was evaluated utilizing the Vaccine Adverse Event Reporting System (VAERS) a passive national surveillance system. Reports of adverse events reported to VAERS in conjunction with an immunization against pertussis (whooping cough) between January 1, 1995 (when the whole-cell vaccine was used exclusively) and June 30, 1998 (when the acellular vaccine predominated) were analyzed. Differences in reported events, categorized according to level of seriousness (fatal, non-fatal serious, less serious), were evaluated for three types of vaccines: Diptheria-tentanus-pertussis (DTP) diptheria-tetanus-whole-cell pertussis-Haemophilus influenzae type b (DPTH) and diptheria-tetanus-acellular (DtaP). The results showed a decline in total adverse events reported in the less serious and non-fatal serious report categories. There was not a concomitant decrease in fatal events; in general these events are rare. The authors conclude that the decrease in the number of less serious reports after vaccination with pertussis-containing vaccines while utilization of the DtaP form of the vaccine was increasing, is consistent with information obtained from clinical trials of the acellular vaccine. In addition, an analysis of the proportional distribution of specific events within each category did not show a substantial increase in any event. No new safety concerns surrounding the administration of acellular pertussis vaccine were identified. .

Purpose

The purpose of this study was to evaluate the safety of infant immunization with acellular pertussis vaccines in the United States utilizing the VAERS data. This particular type of vaccine has been licensed for infants recently and is intended to replace the whole-cell vaccines. Although pre- licensure studies were conducted, post-licensure surveillance on a larger scale is required to ensure safety.

Background

The development of an acellular pertussis vaccine resulted from concerns about the safety of whole- cell pertussis vaccines that arose during the 1970s and 1980s. The acellular pertussis vaccine was initially developed and licensed for older children in 1991, and was more recently (1996) instituted for infants. Although clinical trials conducted during the pre-licensing phase of drug development provide initial information on safety, sample sizes are necessarily limited. This in turn limits the ability to detect the occurrence of very rare adverse events during prelicensure trials. Post licensure surveillance systems, such as the VAERS, provide the opportunity to review data for millions of doses.

The VAERS was established in 1990 to provide information on adverse events associated with vaccinations. Reporting to VAERS is mandated by the National Childhood Vaccine Injury Act for specific adverse events occurring within specified time intervals after listed vaccines. The VAERS reporting form contains information on demographics, vaccinations(s) administered, description of the adverse event, treatment, and severity. Reporting may be done by physicians, nurses, pharmacists, parents, vaccines, and others. The reports to VAERS do not necessarily represent causal relations between vaccinations and adverse events, although they are temporally related events.

Although passive surveillance systems such as the VAERS have their limitations, they do provide the ability to: detect previously unrecognized adverse events, provide additional clinical insight into recognized adverse events, and assess the safety of newly licensed vaccines

Methods

The VAERS data encompassing domestic reports from January 1 1995 through June 1998 were obtained for infants (less than 1 year of age at time of vaccination). Time trends in number of VAERS reports according to severity of adverse event and type of pertussis vaccine were presented. The coding of severity for adverse events was based on definitions from the Code of Federal Regulations: reports of death, non fatal serious events (initial hospitalization, prolongation of hospitalization, life-threatening illness, or permanent disability), and reports of less serious events. In addition, selected reports of adverse events associated with DTP vaccinations were individually reviewed to verify that the reported diagnoses were correctly coded.

Findings

Trend analyses showed a sharp decline in the total number of reported serious and less serious adverse events associated with pertussis vaccine administration during the transition from use of whole-cell pertussis vaccine to predominant use of acellular pertussis vaccine. A similar clear-cut decline was not observed for reports of deaths. An analysis of the proportional distributions of adverse events within the three types of vaccines indicated no specific event was occurring at a substantially higher proportional rate for the acellular vaccine versus the other vaccines. Urticaria (hives) was noted in 7.7% of the DTP vaccine, compared to about 3% for both DTP and DHTP vaccines, but this was not associated with anaphylaxis, and may have been due to the proportional decrease in reports of fever, which are proportionally higher for both the DTP and DHTP vaccines.

Use of Evaluation Results

The safety of the acellular vaccine demonstrated by the pre-licensure clinical trials is confirmed by the current surveillance study.

AGENCY SPONSOR: Center for Biologics Evaluation and Research at the Food and Drug Administration (FDA)

FEDERAL CONTACT: Miles M. Braun, MD, MPH

PHONE NUMBER: 301-827-3974

PIC ID: 7251

PERFORMER ORGANIZATION: Center for Biologics Evaluation and Research at the Food and Drug Administration (FDA), Rockville, MD and the National Immunization Program at the Centers for Disease Control and Prevention (CDC), Atlanta, GA

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National Health Service Corps

Highlights

The National Health Service Corps (NHSC) is a program intended to improve access to health care in underserved areas. The program is conducted under the auspices of the Bureau of Primary Health Care within the Health Resources and Services Administration (HRSA). This evaluation of the NHSC examined the factors that are hypothesized to lead to clinician retention in underserved communities. The study consisted of in-depth surveys of three groups: NHSC alumni clinicians, current clinicians, and NHSC site administrators.

The NHSC program provides either scholarships to currently enrolled students or a loan repayment program for those who recently completed their training. Providers in both programs are then obligated to practice in a high-priority health professional shortage area, or in the case of the loan repayment program, eligible facilities from the Loan Repayment Vacancy List. The agency asserts that many of their providers, in addition to caring for patients, contribute in other ways to medical care at their host sites. This assertion has not been previously studied and became a major focus of this evaluation.

Questionnaires were sent to a stratified sample of 2,160 alumni physicians, advanced practice nurses, dentists, and physicians assistants, who have participated in the program over the past twenty years, as well as to 1,143 currently serving providers. Seventy five percent of current providers and 59% of alumni responded to the survey. (Sixty-two percent of NHSC site administrators also responded to a mailed survey.) Descriptive statistics, univariate, and multi- variate analyses of the data were presented. The predictors included program characteristics, individual provider background characteristics, and self-reported attitudes. Findings were many and complex, given the multiple outcome measures, but generally supported the conclusion that participants in the loan repayment program exhibited better outcomes than did providers in the scholarship program. Other programmatic, attitudinal and background characteristics such as gender, discipline, type of site, site match with provider choice and motivation for entering the program were also associated with various outcomes. Survival analysis using Cox regression models were employed to investigate retention over time.

Main findings were that satisfaction with the program varied according to numerous demographic factors as well as with the type of program (scholarship vs loan repayment) the provider was enrolled in. Providers, primarily physicians, in rural communities have had an impact on their communities in areas other than direct patient care.

Purpose

The purpose of the current evaluation was review the NHSC program in 3 areas: assess the extent to which the NHSC is fulfilling its mission, improving clinical practice standards in underserved areas, and contributing to the community in other areas; identify factors that influence the quality of service and retention; and assess the impacts of changes in program objectives and expectations on development of the NHSC.

Background

The NHSC was established in 1971 and is part of a larger Federal effort designed to improve the delivery of health services to persons in currently underserved areas. Primary health care professionals, including physicians, dentist, nurse practitioners, physician assistants, certified nurse midwives, and others, are recruited and placed in underserved areas through two methods: 1) scholarship programs, which require assignment to a specific area for the length of service equal to the scholarship term; and 2) loan repayment, which requires assignment to a wider variety of sites while NHSC assists with repayment of loans incurred during clinical training. Although the mission of the program has changed only slightly, the approach and levels of funding available to the program have varied greatly over the 25 years since inception. As of August 1999, when the study was conducted, there were approximately 1,863 NHSC clinicians in the field; 70% were federal loan repayment participants and 30% were scholarship recipients. More than half of the clinicians in the field at that time period were physicians (51%), 14% were dentists, 14% were physician assistants, 11% were nurse practitioners, and 3% were nurse midwifes. The remaining 7% were in disciplines considered to be out of the scope of the current evaluation (mental health workers, marriage therapists, etc.). Previous evaluations have focused primarily on physicians, rural areas, and scholarship programs. The current effort broadens the scope of the program evaluation.

Methods

Information was obtained via mail surveys of NHSC current and former clinicians, and NHSC sites administrator. The surveys were self-administered and contained both structured and open-ended questions. The objectives of the surveys were to assess clinician impact on the sites and communities, and to assess factors that influence both retention at the site and subsequent career objectives of the NHSC clinician. The clinician surveys evaluated experience before NHSC service; NHSC service; service impacts; satisfaction with practice setting; education and employment history; and socio-demographic characteristics. The site administration survey covered the site historical involvement with the NHSC program; site clinical services; compensation approach; and NHSC recruitment and retention record.

Findings

Response rates for survey returns were 75.2% for current clinicians, 58.9 for alumni clinician, and 62.1% for site administrators. Important motivations for joining the corps were financial need and a desire to work with underserved populations based on altruistic motivation (as measured by a composite of three questions). Overall satisfaction levels among alumni and current clinicians are not high, and were found to vary by such factors as discipline, type of community, gender, age at start of service, and ethnicity. Selected findings are: Scholarship program participants are less satisfied than loan repayment clinicians, possibly due to less choice in sites for work effort. Non- physician primary care workers are more satisfied with both compensation and job situation than are physicians. Rurally located clinicians are less satisfied than those at other sites; female clinicians and their families report lower satisfaction compared to males, as do younger participants.

The study also revealed that NHSC clinicians have had an impact on their communities in areas other than direct patient care. These include accessing new patient populations; increasing and adding services, initiating community-oriented primary care programs, participating in quality assurance activities, and engaging in leadership activities. This is more true for those clinicians in rural communities than those in urban areas.

Use of Evaluation Results

Results can be utilized to assist the NHSC program select applicants who are well suited to carry out the mission of the corps. The selection and recruitment process can be improved by matching NHSC clinicians to communities that provide a good fit, leading to higher performance and increased retention.

AGENCY SPONSOR: Bureau of Primary Health Care at the Health Resources and Services Administration (HRSA)

FEDERAL CONTACT: Richard Niska, MD

PHONE NUMBER: 301-594-4204

PIC ID: 6357

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

Environmental Assessments

ENVIRONMENTAL ASSESSMENTS

The Low Wage Labor Market: Challenges and Opportunities for Economic Self-Sufficiency

Highlights

This study represents a synthesis of current literature on the low-wage labor market. The purpose of the study is to identify labor market factors that influence the prospects of former welfare recipients finding work leading to economic self-sufficiency. The study consisted individual papers on specific labor market topics prepared by nine experts in the low wage labor market field. The study topics included (1) description of the low-wage labor market and how has it changed over time, (2) policies affecting the low wage labor market, (3) identification of barriers to entering the low-wage labor market, and (4) barriers to advancement in the low wage labor market. The nine experts highlighted several policy options for improving the wage, employment, and economic self-sufficiency outcomes of low-wage workers.

The research methodologies included a comprehensive literature review of labor market studies, evaluations of job training programs and other labor market related policies, and review of existing labor market data covering the 1960's to the present. The study also includes a compilation of labor market data from the Current Population Survey, the Bureau of Labor Statistics, and the Survey of Income and Program Participation.

The study concluded that the nation’s labor market will be able to absorb the welfare recipients leaving welfare for work as long as the economy remains strong, but there will be regional disparities in the rate of absorption. There will be fewer low-wage opportunities in urban areas and in the South and West regions of the country. In terms of economic self-sufficiency, the study makes it clear that former welfare recipients will continue to be concentrated in jobs that are low-wage, have few fringe benefits, little opportunity for advancement, and are subject to high turnover. The policy recommendations to improve the wage, employment, and economic self-sufficiency of low-wage workers include: (1) policies to improve labor market access and job retention, (2) policies to encourage or support occupational mobility/job advancement, (3) policies to raise the incomes of low wage workers and enhance employment security.

Purpose

There is an increased emphasis on moving welfare recipients into employment. The labor market faced by these individuals differs from the general model of a labor market in that the jobs do not have opportunities for advancement, little job security, and the individuals are subject to gender and racial discrimination to a greater degree. Due to the substantial size of this workforce, a characterization of the workforce and the polices that affect it was undertaken.

Background

Policy makers are concerned about the impact of moving welfare recipients into employment as a result of welfare reform. The impact of these changes on the labor market’s ability to absorb these new workers, the opportunities that are available, and the effects of changes in the larger economy are largely unknown. The U.S. Department of Health and Human Services, Office of the Assistance Secretary for Planning and Evaluation, commissioned nine papers by expert in labor market analysis, requesting they review the current literature on the low-wage labor market and highlight policy implications. This document represents a compilation and summary of those reviews. The papers characterized the low-wage labor market, how it varies over time, and how outcomes vary for different populations and regions. Three other papers addressed the impact of specific policy interventions intended to increase income or employment among the working poor. Two papers addressed the barriers to employment experienced by disadvantaged workers. The last two papers reviewed opportunities for advancement and job-related benefits in the low wage labor market.

Methods

This document represents a collection of papers by experts, who reviewed the literature relevant to their area of expertise. The literature was reviewed with the purpose of providing assessments of policies.

Findings

Each reviewer provided a number of findings and recommendations. A summary of key findings includes the following: The wage level of low income workers has declined over time. These low- wage workers are disproportionately female, minority, non-college-educated, non-union and concentrated in retail trade. Although the skill level of low-wage workers has steadily increased over time, there has not been a concomitant increase in wage share. Individuals with high school or less have higher unemployment rates, and earn less. The number of low-wage jobs is cyclical. Labor prospects for former welfare workers are less than those for other groups of workers. There is a falling demand for low-skilled labor. There are regional differences in the characterization of the job market. There has been real growth in the employment rate of single mothers, but in many cases there has been no real difference in net income. The labor market will be able to absorb the influx of individuals leaving the welfare rolls only of the economy remains strong. Specific areas of the country may experience difficulty if the economic conditions change. Jobs for welfare recipients are limited, given the skill levels and educational background of most welfare recipients. Public job creation does appear to generate new jobs for low-skill workers, if the earned Income Tax Credit does increase employment for single-parent families. Barriers to employment for low-wage workers include racial discrimination, lack of information about and access to suburban jobs, and lack of effective networks and contacts. Informal referrals may produce a segregated workforce that actually acts as a barrier to those not within the network. Training programs and work programs have only small effects. Less-educated workers are disproportionately affected by turnover.

Use of Evaluation Results

Several policies are highlighted that the authors feel will improve the wage employment and economic self-sufficiency outcomes of low-wage workers. These include:

  • Continued support for programs that improve access to the labor market, such as labor market information, and job retention, including job retention counseling and career planning. There is a recognition that other factors, such as availability of childcare and transportation assistance are also critical.
  • Policies that encourage and support job advancement. These include on the job training and career ladders for entry-level jobs.
  • Policies that raise the income of low age workers and enhance their employment security. These include the Earned Income Tax Credit, minimum wage strategies and public and community jobs strategies.

AGENCY SPONSOR: Office of the Assistant Secretary for Planning and Evaluation in the Office of the Secretary (OS)

FEDERAL CONTACT: Kelleen Kaye

PHONE NUMBER: 202-401-6634

PIC ID: 7425

PERFORMER ORGANIZATION: Urban Institute, Washington DC

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A National Study of Assisted Living for the Frail Elderly

Highlights

This report represents the first in a series of planned reports based on data collected from surveys of a national probability sample of assisted living facilities (ALFs). The philosophy of assisted living is desirable to a variety of stakeholders, and the growth of such facilities has been extensive. Due to the variability in both the definition and regulation of such facilities across states, there are concerns about both the quality of care and consumer protection issues. This report is intended to provide a descriptive overview of a stratified random sample of such facilities, including services provided, costs, and consumer satisfaction. The overall study will review trends in demand for and supply of ALFs; identify barriers to the development of ALFs and determine the extent to which the current supply of facilities meets the concept of “Assisted living”; define what the ALF concept embodies; and look at key features that affect consumer satisfaction, autonomy, affordability, and potential to receive nursing home level of care. The current study is the first step in the process, and provides a descriptive look at basic characteristics of the industry, particularly in terms of services, accommodations, and price.

The study found there are approximately 11,432 ALFs nationwide, with about 650,000 beds. The average occupancy rate is 84%. Most ALFs offered some degree of privacy, with approximately 50% of the units comprised of a one-bedroom, single occupancy apartment. The study also determined that places called ALFs differed greatly with respect to a variety of factors. The extent to which the environment and services of the facilities match the philosophy of assisted living is mixed. Although residents can age in place to some degree, those requiring extensive help with transfers or whose cognitive impairment was moderate to severe could not remain at these facilities. In general, it was determined assisted living was not affordable for moderate and low-income persons aged 75 or older.

Purpose

The purpose of the study is to describe the role assisted living facilities play in providing a residential setting and supportive long-term care services to the elderly. This initial report is primarily descriptive in nature, providing information on the size and nature of the supply of assisted living facilities, the basic characteristics of the industry, and what philosophy is embodied by the current supply of facilities.

Background

There is an increased demand for residential facilities that offer supportive services for the frail elderly due to a rapidly growing elderly population with significant levels of physical disability and mental impairment, a preference of the elderly for in-home and community-based services, and incentives at the state level to constrain theuse of nursing homes. ALFs are defined differently across states, and are regulated by a wide variety of different state agencies.

Methods

The survey utilized a complex, multi-stage sampling design to identify and select assisted living facilities (ALFs). Of the estimated 11,472 potential ALFS identified via external sources (e.g., state licensure agencies, industry trade associations, Internet listings), a stratified random sample of 2,945 places was selected for telephone survey screening. Of these, facility administrators at 1,251 that met eligibility criteria were given an extended telephone survey. The study considered an ALF to meet criteria if it had more than ten beds; served a primarily elderly population, and offered a basic level of services, including 24-hour staff oversight, housekeeping services, at least two meals a day, and some degree of personal assistance.

Findings

The study found there are approximately 11,432 ALFs nationwide, with approximately 650,000 beds. The average occupancy rate is 84%.The average size of an ALF in the survey was 57 beds; 67% had 11-50 beds, 21 percent had 51-100 and 12% had more than 100 beds.

Most ALFs offered some degree of privacy, with approximately 50% of the units comprised of a one-bedroom, single occupancy apartment. Few of the facilities had all-private accommodation; with approximately 28% reporting bedrooms could be shared by three or more residents.

Most of the facilities offered 24-hour staff, three meals a day, and housekeeping. Most (three- quarters) also had some type of nursing staff available either full or part-time Although individuals with moderate disabilities were admitted, fewer than half of the facilities would admit residents who required help with transfers. Those residents with moderate to severe cognitive impairment were also barred from more than half of the ALFs.

The study authors categorized the facilities based on a mix of services and the amount of privacy afforded. The four groups were low/minimal privacy and low/minimal services, representing 59% of the total; high privacy but low services (18%); low privacy, high service (12%) and high privacy and high service (11%). These groups differed significantly from each other, although all called themselves assisted living facilities.

The most common basic price for the facilities ranged from $1000 to $1999 per month, with the high privacy/high service facilities at the top of the range. These rates are largely unaffordable for low- and moderate-income elderly.

Use of Evaluation Results

This report, the first in a planned series, provides a descriptive overview of ALFs, including services provided, costs, and consumer satisfaction. The findings from this report can be used in future discussions to delineate and define the concept and philosophical models of assisted living facilities. The study provides a look at the extent to which the current supply of facilities meets the concept of “assisted living,” and provides definitions of what the concept embodies. Future reports will examine trends in demand for and supply of ALFs; identify barriers to the development of ALFs; and will provide a look at key features that affect consumer satisfaction, autonomy, affordability, and potential to receive nursing home level of care.

AGENCY SPONSOR: Office of Disability. Aging and Long-Term Care Policy at Office of the Assistant Secretary for Planning and Evaluation (ASPE)

FEDERAL CONTACT: Pamela Doty

PHONE NUMBER: 202-690-6613

PIC ID: 4719.7

PERFORMER ORGANIZATION: Meyers Research Institute at Menorah Park,
Beechwood, OH

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Evaluation of the Research Centers in Minority Institutions

Highlights

The Research Centers in Minority Institutions (RCMI) is a congressionally mandated program designed to expand health sciences research in predominately minority institutions. The primary goal of the program has been to enable these institutions to become more competitive in obtaining support for the conduct of biomedical and or behavioral mission of the U.S. Public Health Service. This program, initiated by the National Institutes of Health (NIH), has been underway since 1985; in 1995, NCRR began a two-phase evaluation of the program to assess the extent to which the goals and objectives of the program are being met.

The current evaluation design addressed six questions:

  • Have RCMI institutions been more successful than similar non-RCMI institution in competing for PHS grants?
  • Is this level of success affected by prior research experience?
  • Has the success been long-term?
  • Are there intermediate indicators of success?
  • What characteristics are most related to success?
  • Does the academic research environment affect success?

Information was obtained from interviewing the centers and conducting a site visit, from a review of program record documents; and database searches of secondary data sources

In general the 15 RCMI institutions showed a greater improvement in competing for research grants, with somewhat more experienced centers demonstrating a greater percentage increase in research project grant (RPG) funding per year than either inexperienced or highly experienced centers. The recommendations from the review include a set of data elements that need to be collected to enhance the quality of future evaluations of the program.

Purpose

Phase I of this evaluation, begun in 1995, was intended to look at the first 10 years of RCMI program implementation. This report represents the results of Phase II of the RCMI Program evaluation, which incorporates the plan and methodology developed in Phase I.

The purpose was to provide a scientifically sound evaluation of the 15 RMCI centers that have been funded for at least 10 years to enhance understanding of the program success and program characteristics and activities; to identity best practices implemented at different centers; and develop an improved process for selecting and monitoring the progress of the RCMI centers.

Background

The RCMI program is intended to enhance the research capabilities of institutions with predominately minority student enrollments that offer doctoral degrees in the health professions or in a health-related science. The institutions have historically not participated extensively in NIH research programs. RCMI grants have been awarded to 21 institutions to date, although only 15 have been funded for more than 10 years. The grants provide support for administrative activities, individual faculty member support, and facility enhancement and improvement. Grant recipients all have interest in minority health issues, but differ markedly in their characteristics. Institutions supported include medical schools, graduate school, schools of pharmacy and a school of veterinary medicine. The institutions are both private and state-supported, and range from completely inexperienced in the research area to those with long-standing research programs. The program was initiated in 1985, and therefore has been underway for over 10 years. It was determined a broad-based evaluation was needed to assess the extent to which the goals and objectives of the program were being reached.

Methods

The evaluation was designed as a multiple case study with cross-site analysis, addressing six areas of program characteristics and activities that were hypothesized to have an effect on RCMI success. These characteristics included years of prior research experience and characteristics of the academic research environment. The data included field observations of the RCMI (preceded by a request for specific information prior to the site visit); a review of program records; and data searches of NIH and NSF grant files, bibliometric databases, and other secondary data sources. Comparisons were made between the RCMI and non-RCMI. The comparison non-RCMI group was matched by census region, Carnegie classification, and level of NIH funding prior to 1985. The RCMI were also divided into three groups for within group comparisons based upon level of research funding prior to 1985. The three group identifications were, (1) experienced centers, (2) somewhat experienced centers, and (3) experienced center. The within group comparisons included differences in success in achieving the program outcomes, and differences in organizational and research environmental factors that influenced the outcomes. Both qualitative and quantitative data analysis were conducted to describe the activities of the RCMI, the environmental settings, and research capacity building outcomes. The primary analytical technique was pattern coding, which involved analyzing the items and possible explanations and the patterns to provide factors critical to programmatic success. The preliminary findings were presented to a panel of experts selected by area of research expertise to review the findings and make recommendations to NCRR.

Findings

A summary of the findings of the study are (1) the RCMI showed greater improvement in the completion of grants than the non-RCMI comparison institutions, (2) somewhat experienced institutions showed the best performance in securing competitive grants, (3) the RCMI increased productivity in publications, (4) RCMI increased the number and quality of shared research facilities, upgrading their facilities and equipment, and (5) factors that contributed to some RCMI being more successful than others included scientific leadership, administrative leadership, good management and communication systems, and particularly in less experience institutions, effective strategic planning and self-assessment.

Use of Evaluation Results

The recommendations from the expert panel are (1) NCRR should define and emphasize the long-term goals of the RCMI Program, (2) the NCRR should make it very clear to the administrators of the RCMI that future performance will be measured by demonstrated improvement in competitive research grants, peer-reviewed scientific publications, and successful institutionalization of research capacity to eliminate dependency on RCMI support.

AGENCY SPONSOR: National Center for Research Resources at the National Institutes of Health (NIH)

FEDERAL CONTACT: Patricia A. Vorndran

PHONE NUMBER: 301-435-0866

PIC ID: 5580.1

PERFORMER ORGANIZATION: Macro International Inc., Calverton, MD

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Prescription Drug Coverage, Spending, Utilization, and Prices

Highlights

Although the use of prescription drugs are increasingly improving health outcomes and quality of life, these drugs, and in particular new drugs, are not available to everyone. The elderly and disabled Medicare beneficiaries in particular have either inadequate or no coverage for drugs. Policymakers are currently considering options to make prescription drugs available to all, particularly by expanding the Medicare program; accurate and comprehensive information on drug coverage, drug spending, and drug prices is needed to guide that discussion. The intent of this report is to provide information on drug costs and trends for Medicare beneficiaries. Using a combination of public and private databases, data on coverage, effects of coverage on spending and utilization, and prescription drug prices is provided.

Purpose

The purpose of this study was to examine prescription drug costs and trends for Medicare beneficiaries. This information will be used by policymakers for development of a voluntary Medicare drug benefit as a means to extend drug coverage for senior citizens.

Background

Prescription drugs improve health outcomes, reduce the need for surgery, and can improve the quality of life. New drugs are continually coming on the market with the promise of greater benefits. However, not everyone has access to these drugs. Medicare has never covered the vast majority of prescription outpatient drugs, a common practice for health coverage plans when Medicare was enacted. Most private insurance plans today do provide coverage, and policymakers are aware that this gap in Medicare places a heavy financial burden on beneficiaries. There is a broad plan to modernize Medicare, part of which would involve giving all beneficiaries access to affordable, high-quality drugs

Methods

The data in the report were compiled by the Agency for Healthcare Research and Quality (AHRQ, the Food and Drug Administration (FDA), the Health Care Financing Administration (HCFA) and the Office of the Assistant Secretary for Planning and Evaluation (ASPE). Data were drawn primarily from the 1996 Medical Expenditure Panel Survey (MEPS) and the Medicare Current Beneficiary Survey (MCBS). Additional data were drawn from pharmacy audits conducted by IMS Health, the ongoing Consumer Expenditure Survey (CES) conducted by the Bureau of Labor Statistics and the 1997 National Health Interview Survey. Data on operations of the drug distribution system, industry trends and other information on drug coverage, utilization, spending and pricing were drawn from informal surveys of outside sources such as drug manufacturers and pharmacies.

Findings

Although 85% of Medicare beneficiaries use at least one prescription drug annually, only 54% were covered for a full year during 1996, and 25% had no coverage. Most sources of drug coverage for these individuals are unstable; and drug benefits are becoming less generous. It is expected that drug coverage for retirees will continue to decline. The very old, those who live outside a metropolitan area, and those at the higher end of the poverty spectrum are the least likely to be covered. Currently, rates for prescriptions are higher for those with five or more chronic conditions. There are very significant differences in drug utilization and out-of-pocket spending between those with coverage and those without, regardless of health status. Prescription drugs represent a significant source of spending, taking up about one-sixth of all health spending by the elderly. Cash customers pay more for drugs than do those with third party payments.

Use of Evaluation Results

The study provides a detailed examination of multiple factors related to coverage, utilization, and spending for prescription drugs, particularly for the Medicare population. While providing the requested background, it also raised a number of questions that will require multivariate analyses and an ongoing analysis of more up-to date data to fully answer.

AGENCY SPONSOR: Office of Health Policy at the Office of the Assistant Secretary for Planning and Evaluation (ASPE)

FEDERAL CONTACT: Christy Schmidt

PHONE NUMBER: 202-690-6870

PIC ID: 7506

PERFORMER ORGANIZATION: Office of the Assistant Secretary for Planning and Evaluation at HHS, Washington, DC

Chapter III - Compendium of HHS Agency FY 2000 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) 2000, organized by the following HHS components:

  • Administration for Children and Families (ACF)
  • Administration on Aging (AoA)
  • Agency for Healthcare Research and Quality (AHRQ)
  • Agency for Toxic Substances and Disease Registry (ATSDR)
  • Centers for Disease Control and Prevention (CDC)
  • Centers for Medicare and Medicaid Services (CMS)
  • Food and Drug Administration (FDA)
  • Health Resources and Services Administration (HRSA)
  • Indian Health Service (IHS)
  • National Institutes of Health (NIH)
  • Office of the Assistant Secretary for Planning and Evaluation (ASPE)
  • Office of Public Health and Science (OPHS)
  • Substance Abuse and Mental Health Services Administration (SAMHSA)

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 2000, 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 7,000 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 (ACF)

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 2000 Evaluation Reports

Analysis of Administrative Data on Families Receiving Welfare and Diversion Assistance under the Work First Program: Fourth Quarterly Report

This report is the fourth in a series of quarterly reports involving analysis of administrative data for the Evaluation of the Work First Program. The data examined in the reports are derived from the administrative data systems maintained by the North Carolina Division of Social Services, the North Carolina Employment Security Commission, and other state agencies. The overall goal was to examine patterns of welfare participation, employment, earnings, and other key outcomes among families who enter and leave the Work First program, and persons who receive Diversion Assistance. The study found significant variations among the counties in the number of diversions in relation to overall TANF caseloads; families in the Work First cohorts continue to leave welfare earlier than the original AFDC cohort; within 18 months after leaving welfare, fewer Work First families returned to case assistance than did families in the AFDC exit cohort. There were no differences between the AFDC exit cohort and the three Work First exit cohorts in terms of rates of employment at different times after leaving welfare. Employment rates continued to be stable at between 60 and 65 percent.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Girley Wright
202-401-5070

PIC ID: 6829.5

PERFORMER: Maximus, Inc.
McLean VA

Analysis of Administrative Data on Families Receiving Welfare and Diversion Assistance under the Work First Program: Third Quarterly Report

The North Carolina Work First Program's third quarterly report analyzed administrative data, examined patterns of welfare participation, employment, earnings, and other key outcomes among families who enter and leave the Work First program, and persons who receive Diversion Assistance. The findings show that families in the AFDC entry cohort were more likely to be on assistance 36 months after going on welfare, compared to families in the Work First entry cohort. Data suggest that the Work First program has had far less impact on child-only cases than on other cases. For all entry cohorts, the length of stay on welfare was longer for persons without a work history, persons without a work history and a high school diploma, families that were younger, African Americans, and living in large cities. Fewer families in the Work First, compared to the AFDC exit cohorts returned to cash assistance in the study period. No major differences were found between the exit cohorts in employment rates, which seemed to be influenced more by seasonal factors. All cohorts showed evidence of earning progression after leaving welfare, controlling for seasonal variations.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Girley Wright, 202-401-5070

PIC ID: 6829.4

PERFORMER: Maximus, Inc., McLean VA

Celebrating Cultural and Linguistic Diversity in Head Start: Final Report

This study was commissioned by the Administration on Children, Youth and Families (ACYF) to study the diversity in language and culture of the Head Start population and to identify the range of services provided to this population. Three primary data sources were used to conduct the investigation: data from Head Start Program Information Report (PIR), an annual self-report survey of all Head Start programs; surveys; and site visits to 30 programs, including 58 classrooms. Highlights of the findings include: (1) The children and families served by Head start are diverse in culture and language, listing over 140 languages spoken by Head Start children; (2) nationwide, Head Start staff generally reflected the ethnicity of the children and families they served; (3) classroom observations found that multicultural materials and activities are plentiful; (4) parents reported being pleased with program attempts to respond to the linguistic and cultural uniqueness of their children; (5) parents make substantial cultural contributions to their children's classroom and (6) Head Start provides many services to parents, including life skills classes and educational opportunities. One barrier found by some Head Start programs was the difficulty in finding and coordinating with health service providers who spoke the families' home languages.

AGENCY SPONSOR: Administration on Children, Youth and Families

FEDERAL CONTACT: Gail Joseph, 202-205-8713

PIC ID: 5845

PERFORMER: STRA, Inc., Washington, DC

Evaluating the Quality of Kinship Foster Care: Final Report

The Children and Family Research Center of the School of Social Work, University of Illinois at Urbana- Champaign conducted this project to create and test instruments to measure the quality of kinship foster homes. The instruments were designed for use by foster care providers to evaluate the quality of homes under their supervision. This study was conducted with the aid and support of the Survey Research Laboratory, University of Illinois at Chicago; the Research Triangle Institute; the American Bar Association's Center on Children and the Law and the Child Welfare League of America (CWLA). The study has three phases: (1) item identification and instrument development; (2) field testing of the instruments with African-American, white, and Latino/a respondents; and (3) finalization of a set of recommended instruments for preliminary use in the field. The project team identified, operationalized, and tested core items to assess quality of care across various sites, situations, and cultures. To the extent possible in the course of the study, these items are designed to be sensitive to differences among children (e.g., age groups, handicaps, placement histories) and families (e.g., socioeconomic status, ethnicity). The investigators developed a kinship foster care provider interview, child interview, worker self- administered instrument, and a case record review. These instruments measure quality of care in the kinship home, contextual factors impacting kinship family functioning, and selected indicators of child functioning. This work will provide a foundation for future research on the quality of kinship family care.

AGENCY SPONSOR: Administration on Children, Youth and Families

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

PIC ID: 6852

PERFORMER: University of Illinois, Champaign, IL

Evaluation of Head Start Family Child Care Demonstration: Final Report

This evaluation assessed, over a three-year period, the effectiveness of the Head Start Family Child Care Homes (HSFCCH) demonstration projects, funded by the Agency for Children, Youth, and Families (ACYF) during Fiscal Year 1992. The report will serve in determining the quality of Head Start services provided in FCC homes, and whether these services meet quality standards, including Head Start Program Performance Standards. It also compares services delivered in FCC homes to those delivered in Head Start centers. The eighteen Head Start grantees participating in the demonstration have at least forty children in the year prior to kindergarten entrance enrolled in the HSFCC program, and a comparable number of children enrolled in the center-based program. Children were randomly assigned to the experimental and control groups. Data were collected on the cognitive, socio-emotional and physical development of the two cohorts of children participating in the study. A series of interviews were conducted with parents, family child care providers, grantee staff and administrators. Systematic observation of program service delivery was also employed to assess effectiveness.

AGENCY SPONSOR: Administration on Children, Youth and Families

FEDERAL CONTACT: Louisa Tarullo, 202-205-8324

PIC ID: 4975

PERFORMER: RMC Research Corporation, Portsmouth, NH

Evaluation of North Dakota's Training, Education, Employment, and Management (TEEM) Program: Final Report

The North Dakota Training, Education, Employment and Management (TEEM) program is the state's Temporary Assistance to Needy Families (TANF) program to families, providing the following cash assistance and supportive services: a computerized assessment that results in a social contract and referrals to needed services; incentives to promote work and work effort; sanctions for non-compliance with the program requirements; increased asset limits allowing families to save while on aid; and a benefit cap that precludes TEEM recipients who get pregnant while on aid from receiving additional cash benefits for that child. The evaluation of TEEM monitored program implementation and examined client caseload trends and client characteristics between 1997 and 1999 to measure outcomes. The monitoring effort identified program improvements needed in providing information to recipients on Earned Income tax Credit, more training for TEEM staff on case manager role, and changes in the client assessment process. The client outcome trend data showed that TEEM families retained substantial public assistance from other sources after finding employment; Native Americans increased as the proportion of TEEM adults cases between 1998-1999 and had higher TEEM recidivism rates; the child-only cases increased proportionately and were living with parents receiving disability payments; and the proportion of case closures due to employment declined over time, possibly due to problems with the closure codes.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Girley Wright, 202-401-5070

PIC ID: 6830

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

Evaluation of the Los Angeles GAINs Project

Los Angeles County transformed its previous, education-focused welfare-to-work program into a Work First program without having to reorganize its welfare agency. The implementation of Jobs-First GAIN succeeded due to commitment from top administrators within DPSS and the administrative authority to carry out the changes. Additionally, many DPSS staff and supervisors not only participated, but supported this process. The program had several impacts for single parents. Jobs-First GAIN led to substantial two- year increases in employment and in earnings. The program produced fairly modest reductions in welfare and Food Stamp receipt and large reductions in welfare and Food Stamp payments. There was a small increase in total income in year 2. With regards to medical care, the program did produce a shift from public to private insurers. The use of child care increased as well as the incidence of child care problems that had effects on employment. The program achieved larger employment and earnings gains than the country's previous, basic-education focused programs. The program's two-year impacts on earnings and welfare expenditures were somewhat larger for members of two-parent families than for single parents. Jobs-First GAIN increased two-year earnings for both men and women in two-parent families, although the average earnings gain for men was nearly twice that for women.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Lawrence Wolf, 202-401-5084

PIC ID: 6840

PERFORMER: Manpower Demonstration Research Corporation, New York, NY

Evaluation of the North Carolina Work First Program: Study of Families Leaving Work First in Selected Counties - Results of the First Round of Follow- up Surveys

The evaluation of the North Carolina Work First program includes a report on results of the second round of follow-up surveys in late 1999 on the status of families who left the programs in August 1998 as a result of reaching the 24-month time limit. The first round of surveys were conducted between December 1998 and March 1999. Between the first and second survey rounds, the employment changes experienced by leaving families showed that: employment was slightly higher; the rates of job turnover were not significant; almost half of respondents said they received a raise between interviews (however, the earning progress ion may be unique to the sample and all welfare leavers). As for employer health insurance, participation increased for respondents, but largely because they became eligible to participate in plans because of increased time on the job and increased work hours. The two reasons given by respondents who were unemployed at the second round were: (1) could not find a job or get one after applying and; (2) disability or illness. There was an increase in the number of respondents who said they had experienced adverse events since leaving, with ability to buy food as the one mentioned most often. No significant differences were found for access to health care, child care, and housing, nor differences in children's school performance. Employed respondents with higher incomes thought they were better off without welfare, but the pattern was inconsistent at the lower income levels.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Girley Wright, 202-401-5070

PIC ID: 6829.2

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

Feedback From Potential Users of a Comprehensive Welfare Rules Database: Final Report

This report describes the reactions of researchers, policy makers, and state welfare administrators to the possibility of a comprehensive database of states' rules for providing cash assistance to low-income families with children--specifically, AFDC/JOBS rules for 1996 and prior years, and TANF rules for 1997 and future years. The goal was to obtain feedback on specific aspects of a comprehensive welfare rules database, and to provide insight into the broader question of whether a single database is an appropriate and achievable goal. The database used to generate comments and discussions for this project is the Urban Institute's Welfare Rules Database (WRD), under development for the past three years. The database currently focuses on welfare rules and does not include information on budgets, caseloads, outcomes, or administration. WRD project staff obtained comprehensive feedback and the report provides a list of nine recommendations for a useful database. After considering the recommendations, Urban Institute staff and HHS staff determined that the best area for immediate improvement was the documentation. Urban Institute staff prepared a users guide and wrote documentation of the categories of information as well as the specific variables.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Alan Yaffe, 202-401-4537

PIC ID: 6837

PERFORMER: Urban Institute, Washington, DC

Final Results from Florida's Family Transition

In 1994, Florida started the Family Transition Program (FTP) as a pilot test site in Escambia County, the first welfare reform initiative to test time limits for eligibility and continued benefits. Families were limited to only 24 months of assistance during a 60-month period (36 months out of 72 for the least job ready) and were provided services and incentives to find work. The evaluation was a random assignment comparison group study of welfare recipients placed in the FTP and others receiving traditional Aid to Families with Dependent Children (AFDC) benefits. The findings showed that FTP recipients, compared to those in the AFDC group, and had lower length of time on welfare, had few positive or negative impacts on children, with the exception of adolescents and their school performance. FTP families gained in income more than they lost in welfare payments. Slightly less than half of the FTP families who reached their time limits were able to work steadily in the subsequent 18 months, many relying on family, friends, Food Stamps, and housing assistance. The conclusion was that time limits can be imposed without widespread impact on families, but that the robustness of the local economy may be a strong contributing factor.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Alan Yaffe, 202-401-4537

PIC ID: 6820

PERFORMER: Florida Department of Children and Families, Tallahassee, FL

OCSE Responsible Fatherhood Programs: Early Implementation Lessons

In 1997, the Office of Child Support Enforcement (OCSE) funded Responsible Fatherhood Demonstration Projects in eight states to improve the employment and earnings of under- and unemployed noncustodial parents, and to motivate them to become more financially and emotionally involved with their children. This report is an early implementation analysis of the programs and focuses on (1) how they are administered; (2) the types of services they deliver; (3) the coalitions they fcreated with community-based organizations and state and local service agencies; (4) how they recruit program participants; and (5) how they monitor client progress. The report also outlines 10 lessons learned from the early experiences of the programs with implementation and operation. This preliminary assessment of the projects demonstrates that there are many different paths to pursue in the quest to achieve the program's goals.

AGENCY SPONSOR: Office of Child Support Enforcement

FEDERAL CONTACT: David Arnaudo, 202-401-5364

PIC ID: 7055

PERFORMER: Lewin Group Fairfax, VA and The Johns Hopkins University, Baltimore, MD

Reforming Welfare and Rewarding Work: Final Report on the Minnesota Family Investment Program

This report is published in three volumes: a summary report and two separate reports on the program's impacts on adults (Vol. 1) and children (Vol. 2). It is the final report from an evaluation by MDRC of the Minnesota Family Investment Program (MFIP). The experimental program in Minnesota was designed without time limits and long before the passage of the landmark federal welfare reform law. Minnesota officials hoped that a new system that combined financial incentives to work with participation or work requirements for long-term recipients would increase work, reduce long-term welfare dependence, and reduce poverty for working families. For the group involved in this study, the program increased work, increased earnings, reduced the use of welfare as a sole income source, reduced poverty, reduced domestic abuse, and reduced children's behavior problems and improved their school performance.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Lawrence Wolf, 202-401-5070

PIC ID: 6824

PERFORMER: Manpower Demonstration Research Corporation, New York NY

Study of Families Leaving Work First Due to Time Limits: Results of the Second Round of Follow-up Surveys

The North Carolina Work First Program's third quarterly report analyzing administrative data examined patterns of welfare participation, employment, earnings, and other key outcomes among families who enter and leave the Work First program, and persons who receive Diversion Assistance. The findings show that families in the AFDC entry cohort were more likely to be still on assistance 36 months after going on welfare compared to families in the Work First entry cohort. Data suggest that the Work First program has had far less impact on child only cases than on other cases. For all entry cohorts, the length of stay on welfare was longer for persons without a work history, persons without a work history and a high school diploma, families that were younger, African American, and living in large cities. Fewer families in the Work First, compared to the AFDC, exit cohorts returned to cash assistance in the follow up study period. No major differences were found between the exit cohorts in employment rates, which seemed to be more influenced by seasonal factors. All cohorts showed evidence of earning progression after leaving welfare, controlling for seasonal variations.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Girley Wright, 202-401-5070

PIC ID: 6829.3

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

Study of Families Receiving Diversion Assistance Payments Under the Work First Program

The North Carolina Work First Diversion Assistance program serves families eligible for Work First cash assistance but instead receive diversion assistance in the form of cash payments equal to as much as three months of Work First benefits. The program goal is to provide assistance to families when they need short-term help to become or remain self-sufficient, as an alternative to going on welfare. The evaluation consists of telephone interviews with 242 families receiving assistance between May 1999 and August 1999. The study found client household characteristics, plus prior welfare use and employment, varied by county which was interpreted as variations in the county's approach to targeting diversion assistance. One quarter of respondents said they were not working. Overall, there is evidence of food deprivation among 22 percent of respondents but no evidence of major problems of hunger, homelessness, poor housing conditions, or placement of children. The results suggest that county administration of the programs should take caution in using diversion for applicants that do not have a recent work experience.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Girley Wright, 202-401-5070

PIC ID: 6829.1

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

The Potential of the Child Support Enforcement Programs to Avoid Costs to Public Programs: A Review and Synthesis of the Literature

The Child Support Enforcement Programs ensures that non-custodial parents provide appropriate financial support for their children through four major services: locating absent parents, establishing paternity, establishing child support and medical support obligations, and enforcing support orders. One of the goals of the program is to reduce government expenditures on means-tested public assistance programs by increasing the amount of child support paid to custodial households by non-custodial parents. This study synthesizes the theoretical and empirical literature on cost avoidance to build a comprehensive and coherent framework to evaluate the intricacies of child support cost avoidance. The main findings drawn from the literature are: several studies present estimates of cost avoidance, but differences in methodology, populations analyzed and assumptions by the authors make comparability and generalizations difficult to estimate; although realized cost avoidance is relatively modest under the current child support enforcement system, the potential for cost avoidance is unknown; evaluations of several demonstrations found that periodic review and updating of support orders for AFDC cases was effective in avoiding state and federal government costs, that is the overall cost of the process was less than the increase in dollars collected; the literature indicates that child support enforcement has, at most, a limited indirect effect on cost avoidance by changing the marital and childbearing behavior of custodial and noncustodial parents. The current research focuses on custodial parents and suggests that child support enforcement has a small deterrent effect on divorce and little or no deterrent on out-of-wedlock childbearing. The few published studies on the effect of child support on the labor force participation of custodial mothers find mixed results.

AGENCY SPONSOR: Office of Child Support Enforcement

FEDERAL CONTACT: Gaile Maller, 202-401-5368

PIC ID: 6842

PERFORMER: The Lewin Group, Fairfax, VA

Wisconsin's Self-Sufficiency First/Pay for Performance Program: Results and Lessons from a Social Experiment

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. This is a report conducted on behalf of the Wisconsin Department of Workforce Development by the Institute for Research on Poverty (IRP) at the University of Wisconsin- Madison. The task was to conduct a field reconnaissance of Wisconsin's Self-Sufficiency First and Pay for Performance Programs (SSF/PFP). One section of the report identifies the data difficulties and limitations that IRP encountered during its evaluation. Another section examines selected outcomes for AFDC participants who moved to PFP in 1996. The last section provides a summary and conclusion and offers a recommendation concerning future large-scale efforts to operate controlled experiments and monitor their impacts with operational data systems.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Leonard Sternbach, 415-437-7671

PIC ID: 6838

PERFORMER: Wisconsin Department of Workforce Development, Madison, WI

In-Progress Evaluations

A Research Synthesis of the Effects of the Temporary Assistance for Needy Families (TANF) Program

This project will synthesize the most current research information available on the effect of TANF on income, earnings, receipt of government benefits, and family formation and structure, for individuals and families who were potentially affected by welfare reform, including both current and former TANF recipients, as well as others at risk of becoming dependent on cash assistance. It will also synthesize information available concerning the amount and duration of welfare and other benefits such as Medicaid, child care, child support and food stamps. Finally, in addition to synthesizing research in subject areas that have been extensively studied, it will also document areas that have not been studied to identify possible ideas for future research.

EXPECTED DATE OF COMPLETION:12/31/2001

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Alan Yaffe, 202-401-4537

PIC ID: 7540

PERFORMER: Rand Corporation, Santa Monica, CA

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 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.

EXPECTED DATE OF COMPLETION:07/31/2001

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Richard Jakopic, 202-205-5930

PIC ID: 7113

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

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.

EXPECTED DATE OF COMPLETION:03/31/2002

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: John Maniha, 202-401-5372

PIC ID: 6765

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

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.

EXPECTED DATE OF COMPLETION:09/29/2002

AGENCY SPONSOR: Office of Planning, Research and Evaluation

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

PIC ID: 6833

PERFORMER: Center for Impact Research, Chicago, IL

Assessing Enhanced Transitional Employment (ETE) Programs

This project will identify and describe employment-focused programs that help individuals who face significant employment challenges by providing transitional employment or work experience that builds the skills and capacity of participants through a supportive environment that may include close supervision, peer supports, and progressive performance expectations, and linkage or provision of needed services as well as other methods. The project will provide detailed descriptions of the programs identified, an assessment of program capacity and the feasibility of expanding existing programs to serve more participants, and, if not now served, TANF recipients with significant employment barriers; suggestions on how these programs might be replicated in other State/local settings; and an assessment of the feasibility of conducting a large-scale evaluation of such employment strategies, including an impact evaluation based on an experimental design.

EXPECTED DATE OF COMPLETION:09/28/2001

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Girley Wright, 202-401-5070

PIC ID: 7539

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

Assessing Medicaid and Food Stamps Access and Participation

This project, in cooperation with the Robert Wood Johnson Foundation, will help 12-14 States create and analyze performance data on how their Medicaid, SCHIP, and Food stamps enrollment and reapplications are functioning for families. It will identify root causes of problems in these processes, and develop specific implementation plans to solve identified problems and increase participation. In addition, 10 promising practice site visits will be conducted to help develop improvement implementation plans.

EXPECTED DATE OF COMPLETION:12/30/2001

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Michael Dubinsky, 202-401-3442

PIC ID: 7546

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

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.

EXPECTED DATE OF COMPLETION:03/31/2002

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Leonard Sternbach, 415-437-7671

PIC ID: 5548

PERFORMER: California Department of Social Services, Sacramento, CA

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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Girley Wright, 202-401-5070

PIC ID: 6755

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

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.

EXPECTED DATE OF COMPLETION:09/29/2001

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Alan Yaffe, 202-401-4537

PIC ID: 6847

PERFORMER: Multi-Professional Services Contracts, Washington, DC

Child Outcomes Synthesis Project

This project will synthesize the results from the Project on State-Level Child Outcomes, a series of demonstrations in five states that measure the impacts of welfare reform on the well-being of children. Because three of the state demonstrations are expected to publish final results in 2000, with the remaining two final reports coming in late 2001 or early 2002, this project will be completed in two phases. The first phase, to be completed in 2001, will synthesize the results of the first three states, and the second phase will produce a synthesis of all five states' results.

EXPECTED DATE OF COMPLETION:09/30/2002

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Alan Yaffe, 202-401-4537

PIC ID: 7527

PERFORMER: Manpower Demonstration Research Corporation, New York, NY

Comings and Goings: The Changing Dynamics of Welfare

This project will assess the welfare participation of low-income single mother families (i.e., those with incomes below 150 percent of the poverty line) and how the composition of this population has changed over time. It will examine changes in welfare participation and changes in the rate at which different types of families come onto welfare, and analyze changes in the way families leave the welfare rolls. The major questions to be examined are: what are the factors associated with a woman's choice to enter welfare and are they changing? Are women moving off welfare more quickly than before and are they leaving for the same reasons?

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Girley Wright, 202-401-5070

PIC ID: 7530

PERFORMER: Urban Institute, Washington, DC

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)

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Administration on Children, Youth and Families

FEDERAL CONTACT: Louisa Tarullo, 202-205-8324

PIC ID: 6331

PERFORMER: Abt Associates Inc., Cambridge, MA

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.

EXPECTED DATE OF COMPLETION:09/01/2001

AGENCY SPONSOR: Administration on Children, Youth and Families

FEDERAL CONTACT: Louisa Tarullo, 202-205-8324

PIC ID: 3570

PERFORMER: Mathematica Policy Research, Inc., Plainsboro, NJ

Economic Analysis of the Prenatal and Early Childhood Nurse Home Visitation Program

This study examines cost savings to government, resulting from an investment in a program of prenatal and early childhood home visitations that have been studied in a series of three randomized controlled experiments. The experiments were conducted in three different settings (Elmira, Memphis, and Denver) with different sample compositions.

EXPECTED DATE OF COMPLETION:03/31/2002

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Nancye Campbell, 202-401-5760

PIC ID: 7547

PERFORMER: Kempe Prevention Research Center for Family & Child Health, Denver, CO

Economic Independence and Inclusion Model: A Person-Centered Approach

This project is intended to develop and test the feasibility of an effective local/community-based, long-term and holistic service delivery model for individuals with severe or multiple disabilities. The model will be person-centered and -controlled with easy access to a coordinated network of flexible services and supports designed to enhance the opportunity for these individuals to enter and/or remain in the job market under more satisfactory conditions. Review and analysis of research literature and pertinent federal and State policies and programs; conducting 22 case studies of past and present approaches and best practices; designing, field testing (in three sites) and finalizing the desired model; using an expert advisory panel to review all products. The feasibility of the draft/proposed model is currently being tested in three States.

EXPECTED DATE OF COMPLETION:11/15/2001

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Hossein Faris, 202-205-4922

PIC ID: 7544

PERFORMER: McIver, Diana & Associates, Inc., Austin, TX

Evaluating the Survey of Income and Program Participation (SIPP) Welfare Benefits Reporting Using Matched Administrative Records from California

This project will complete a comparative analysis of patterns and trends in welfare participation and reporting in SIPP. It will also determine the accuracy of SIPP program data by comparing it against State administrative records.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Leonard Sternbach, 415-437-7671

PIC ID: 7536

PERFORMER: University of California at Los Angeles, Los Angeles CA

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).

EXPECTED DATE OF COMPLETION:01/30/2001

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Leonard Sternbach, 415-437-7671

PIC ID: 6818

PERFORMER: Arizona State Department of Economic Security, Phoenix, AZ

Evaluation of Community-based Job Retention Programs

This 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 overtime, 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 seady 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.

EXPECTED DATE OF COMPLETION:09/29/2001

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Nancye Campbell, 202-401-5760

PIC ID: 6760

PERFORMER: Pittsburgh Foundation, Pittsburgh, PA

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 client barriers study oversampling rural areas will be conducted.

EXPECTED DATE OF COMPLETION:09/29/2002

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Michael Dubinsky, 202-401-3442

PIC ID: 6826

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

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 DevelopmentalContinuity, 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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Administration on Children, Youth and Families

FEDERAL CONTACT: Mary Bruce-Webb, 202-205-8628

PIC ID: 4393

PERFORMER: University of Alabama, Birmingham, AL

Evaluation of the North Carolina Work First Program

This begins a series of quarterly reports involving analyses of administrative data for the Evaluation of the Work First Program derived from the North Carolina Division of Social Services, the North Carolina Employment Security Commission, and other state agencies. The major goals of the ongoing analyses are as follows: to examine patterns of welfare participation, employment, earnings, and other key outcomes among families who enter and leave the Work First program, as well as among persons who receive Diversion Assistance; to compare these patterns with welfare receipt and employment among persons who first entered welfare under the AFDC program; to compare different sub-groups of welfare recipients in terms of their welfare participation, employment, and return to welfare (recidivism) in order to identify "hard-to-serve" groups; to perform "multivariate" analyses to identify the factors and characteristics associated with short-term and long-term welfare receipt and success in the job market; to compare welfare and employment outcomes among different counties to help identify issues relating to the effectiveness of different county Work First programs; and conduct analyses of "special topics" identified each quarter by the Division of Social Services. The analyses will provide DSS with useful information and feedback on key policy issues and program impacts relating to the Work First program.

EXPECTED DATE OF COMPLETION:09/29/2001

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Girley Wright, 202-401-5070

PIC ID: 6829

PERFORMER: Maximus, Inc., McLean VA

Experience of Tribal TANF Programs: Problems, Solutions and Lessons Learned

This project will develop national-level research information on tribal TANF programs that will be responsive to the needs of Native American tribal governments in deciding to initiate or improve their own TANF programs, as well as the needs of policymakers at federal, State and local levels. The project will include a survey of all TANF tribes funded as of August 30, 2000 and a sample of non-TANF tribes, supplemented by in-depth on-site case studies of a sample of nine tribes. Uses a combination of qualitative and quantitative data and analytical methods.

EXPECTED DATE OF COMPLETION:11/15/2001

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Hossein Faris, 202-205-4922

PIC ID: 7542

PERFORMER: Support Services, Inc., Silver Spring MD

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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Girley Wright, 202-401-5070

PIC ID: 6761

PERFORMER: Iowa Department of Human Services, Des Moines, IA

Fragile Families and Welfare Reform

This project will describe the conditions and capabilities of vulnerable mothers and fathers in the years following enactment of PRWORA and examine the complex relationships between this new legislation and families' economic and non-economic wellbeing. The project will also document the composition of the actual and eligible welfare caseload, how unwed mothers are packaging various forms of support and government programs, and how well families are doing as a result of individual efforts and social policies. The Fragile Families survey includes a random sample of new unmarried mothers and fathers across 20 large cities that can be made representative of all large cities in the United States. The cities are stratified by policy regime and labor market strength so they represent the entire array of economic and policy conditions in the U.S. Second, the extremely high response rates among mothers and fathers in the study allow us to generalize with confidence to the entire population of eligible urban TANF recipients. Third, the individual-level records will be linked to city and state policy variables, allowing for the analysis of the relationships between policies and a number of outcomes including the types of assistance upon which people rely and individual well-being.

EXPECTED DATE OF COMPLETION:08/31/2003

AGENCY SPONSOR: Office of Planning, Research and Evaluation

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

PIC ID: 7534

PERFORMER: Columbia University, New York, NY

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 conducted in-depth observations in three local offices from each of four States. 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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Michael Dubinsky, 202-401-3442

PIC ID: 6841

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

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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Girley Wright, 202-401-5070

PIC ID: 5980

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

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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Administration on Children, Youth and Families

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

PIC ID: 6848

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

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.

EXPECTED DATE OF COMPLETION:09/29/2002

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Leonard Sternbach, 415-437-7671

PIC ID: 6828

PERFORMER: New Hampshire DHHS, Concord, NH

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).

EXPECTED DATE OF COMPLETION:04/30/2002

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Alan Yaffe, 202-401-4537

PIC ID: 6869

PERFORMER: Indiana Family and Social Services Administration, Indianapolis, IN

Job Opportunities for Low -Income Individuals (JOLI) Program

This project will provide training and technical assistance, logistical support, 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 program and to disseminate the project results to the Congress and other interested parties.

EXPECTED DATE OF COMPLETION:09/29/2002

AGENCY SPONSOR: Office of Community Services

FEDERAL CONTACT: Nolan Lewis, 202-401-5282

PIC ID: 6430

PERFORMER: Trans-Management Systems Corporation, Washington DC

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.

EXPECTED DATE OF COMPLETION:12/31/2003

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Hossein Faris, 202-205-4922

PIC ID: 6835

PERFORMER: Manpower Demonstration Research Corporation, New York, NY

Maryland Family Investment Program Evaluation

This was 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 was to help clarify the relationship between agency factors and county-level characteristics by describing county-level variation in front-line procedures.

EXPECTED DATE OF COMPLETION:09/29/2001

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Lawrence Wolf, 202-401-5084

PIC ID: 6823

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

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.

EXPECTED DATE OF COMPLETION:09/30/2002

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Lawrence Wolf, 202-401-5084

PIC ID: 6825

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

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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Administration on Children, Youth and Families

FEDERAL CONTACT: Mary Bruce-Webb, 202-205-8628

PIC ID: 5848

PERFORMER: Abt Associates Inc., Cambridge, MA

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.

EXPECTED DATE OF COMPLETION:09/30/2003

AGENCY SPONSOR: Administration on Children, Youth and Families

FEDERAL CONTACT: Mary Bruce-Webb, 202-205-8628

PIC ID: 6748

PERFORMER: Research Triangle Institute, Research Triangle Park, NC

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 study the relation of child care subsidies to 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.

EXPECTED DATE OF COMPLETION:01/30/2003

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Richard Jakopic, 202-205-5930

PIC ID: 6845

PERFORMER: Abt Associates Inc., Cambridge, MA

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.

EXPECTED DATE OF COMPLETION:02/28/2005

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Girley Wright, 202-401-5070

PIC ID: 6763

PERFORMER: Rand Corporation, Santa Monica, CA

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.

EXPECTED DATE OF COMPLETION:09/29/2001

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Leonard Sternbach, 415-437-7671

PIC ID: 6827

PERFORMER: New Hampshire DHHS, Concord, NH

New Jersey Substance Abuse Research Demonstration

This evaluation will provide information about the effectiveness of a type of evaluation several states are experimenting with to move substance abusing welfare clients toward self-sufficiency. The intervention New Jersey is implementing includes screening welfare recipients for substance abuse problems, treatment referral mechanisms with enhanced case management, and substance abuse treatment coordinted with employment and training or vocational services. The intervention being evaluated is intended to improve the post welfare prospects of TANF recipients with substance abuse problems. The evaluation is being conducted in two New Jersey counties, Essex County and Atlantic County.

EXPECTED DATE OF COMPLETION:09/29/2001

AGENCY SPONSOR: Office of Planning, Research and Evaluation

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

PIC ID: 7528

PERFORMER: Mount Sinai School of Medicine, New York NY

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.

EXPECTED DATE OF COMPLETION:09/30/2002

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Leonard Sternbach, 415-437-7671

PIC ID: 6758

PERFORMER: Ohio Department of Human Services, Columbus, OH

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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Lawrence Wolf, 202-401-5084

PIC ID: 6799

PERFORMER: Children's Hospital, Denver, CO

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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Office of Child Support Enforcement

FEDERAL CONTACT: Debra Pontisso, 202-401-4548

PIC ID: 6844

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

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.

EXPECTED DATE OF COMPLETION:12/31/2001

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Girley Wright, 202-401-5070

PIC ID: 6757

PERFORMER: University of Colorado Health Sciences Center, Denver, CO

Rural Welfare to Work Strategies Project

As part of its multifaceted national strategy for welfare reform research and evaluation, ACF is funding the Rural Welfare to Work Strategies Demonstration Evaluation Project to learn how best to help TANF and other low-income rural families move from welfare to work. The demonstration evaluation will lead to increased information on well-conceived rural welfare to work strategies and lessons about the operational challenges and methods to address them that can be used by state and local TANF agencies and others. It is expected that four states/sites will participate in the national demonstration evaluation. The project will address the following key questions: 1) what types and packages of services are provided under the RWtW project, and how do they compare with services already available under TANF or other funding? 2) What are the issues and challenges associated with implementing and operating the service packages and policy approaches studies? 3) What are the net impacts of selected approaches under the project on employment and on families' well-being? 4) What are the net costs of the programs, and do the programs' benefits outweighs the costs? 5) What strategies should policymakers and program managers consider in designing approaches to improve the efficacy of welfare to work strategies for families in rural areas?

EXPECTED DATE OF COMPLETION:09/28/2005

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: James Dolson, 202-260-6165

PIC ID: 7247

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

Sexual Abuse Experiences of Runaway Youth

This project responds to a legislative requirement to conduct a study that will address the extent to which sexual abuse exists in runaway youths, and provide information about the perpetrators of any such abuse. The project will review available literature and conduct secondary analyses to examine the sexual abuse experiences of runaway youth, particularly experiences that occur prior to the youths' leaving home.

EXPECTED DATE OF COMPLETION:12/31/2001

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Mary Bruce Webb, 202-205-8628

PIC ID: 7549

PERFORMER: Research Triangle Institute, Research Triangle Park, NC

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

Using experimental methodology, this project continues 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.

EXPECTED DATE OF COMPLETION:04/30/2002

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Lawrence Wolf, 202-401-5084

PIC ID: 6819

PERFORMER: Manpower Demonstration Research Corporation, New York, NY

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.

EXPECTED DATE OF COMPLETION:09/29/2001

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Girley Wright, 202-401-5070

PIC ID: 6762

PERFORMER: Iowa Department of Human Services, Des Moines, IA

Study of Screening and Assessment in the Temporary Assistance for Needy Families/Welfare to Work (TANF/WtW) Programs

This project will highlight and discuss critical issues in the development and use of screening and assessment tools designed to identify TANF and/or WtW recipients who experience barriers to employment. The barriers of specific interest for this study include substance abuse, mental health or illness, low basic skills, physical/developmental disabilities (including learning disabilities) and domestic violence. The project will describe state and local efforts to incorporate screening and assessment tools and procedures in their efforts to assist these recipients make the transition from welfare to work. Finally, this project will provide opportunities for federal, state, a and local TANF/WtW staff and other interested parties share information on screening and assessment.

EXPECTED DATE OF COMPLETION:08/31/2002

AGENCY SPONSOR: Office of Planning, Research and Evaluation

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

PIC ID: 7538

PERFORMER: Urban Institute, Washington, DC

Testing Non-experimental Methodologies Using the National Evaluation of Welfare-to-Work Strategies (NEWWS) Data

The purpose of this demonstration is to test various non-experimental evaluation techniques. The emphasis of this demonstration will be to test whether an adequate control group (not randomly assigned) can be established using propensity score matching techniques as described in recent research literature. The data to be used will be from the NEWWS demonstrations that involved efforts to improve employment and earnings outcomes of welfare recipients at a number of sites. In the NEWWS demonstrations, evaluations were carried out using random assignment to establish treatment and control groups at each site. This demonstration will test modeling techniques by comparing outcomes from the randomly assigned control groups to the outcomes from control groups defined by non-experimental methodologies. This demonstration will deal with data from seven NEWWS sites.

EXPECTED DATE OF COMPLETION:08/20/2001

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Leonard Sternbach, 415-437-7671

PIC ID: 7541

PERFORMER: Manpower Demonstration Research Corporation, New York, NY

The Fiscal Effects of Welfare Reform

Building on a four-state pilot project, this study will conduct case studies in 13 states to assess how social services spending and policies have changed after welfare reform was implemented. More specifically, the study will examine changes in spending in absolute dollars, in real dollars per poor person, and as a percentage of state budgets. This will provide insights into how state budgetary priorities have changed, to learn about trends and differences across states, and to target inquiries about underlying state policy changes that have led to spending changes.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Michael Dubinsky, 202-401-3442

PIC ID: 7545

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

The Illinois Families Study

As families transition from welfare to work in the context of welfare reform policies, large variation in welfare use, income, employment and training, and health care coverage is inevitable. This project capitalizes on this variation to assess the relationship between each of these factors and multiple measures of child well-being within the TANF recipient population. The focus of the research is the first three (3) years of an ongoing panel study involving 1,500 families who were receiving TANF in late 1998. Annual survey interviews assess parental reports of each child's academic performance, behaviors, and health, as well as key risk and protective factors. The survey data will be combined with administrative data from the public welfare system, the unemployment insurance system, children's school records, medical chart reviews of a subset of children from the sample, and Medicaid claims data.

EXPECTED DATE OF COMPLETION:09/29/2002

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Alan Yaffe, 202-401-4537

PIC ID: 7533

PERFORMER: Northwestern University, Evanston IL

Time Limits, Welfare Transitions, and the Age Distribution of Children Receiving Welfare

This demonstration will analyze the effects of time limits on welfare entry, welfare exist, and the age distribution of children receiving welfare. The analysis will use SIPP data from the 1985 through the 1996 panels covering September 1984 through February 1998. The analysis will be of welfare spells of female- headed households. The effects of time limits will be determined by considering the implementation dates of time limits that States implemented under waivers prior to the passage of PRWORA. Various demographic and economic state-level variables will be incorporated into the models to be used.

EXPECTED DATE OF COMPLETION:08/31/2002

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Leonard Sternbach, 415-437-7671

PIC ID: 7537

PERFORMER: University of California at Los Angeles, Los Angeles CA

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.

EXPECTED DATE OF COMPLETION:09/29/2002

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: John Maniha, 202-401-5372

PIC ID: 6831

PERFORMER: Virginia Commonwealth University, Richmond, VA

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.

EXPECTED DATE OF COMPLETION:09/30/2002

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Girley Wright, 202-401-5070

PIC ID: 6764

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

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.

EXPECTED DATE OF COMPLETION:09/30/2002

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Hossein Faris, 202-205-4922

PIC ID: 6832

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

What Works Best for Whom: Effects of Welfare Reform Policies on Subgroups of Current and Former Welfare Recipients

This project investigates the effects of recent welfare policies on various subgroups of welfare recipients. It adds to earlier work on subgroups by adding more programs to the analysis, looking at more outcomes, looking at more subgroups, and including longer follow-up for some programs. The major goals of the project are to help program operators target precious resources toward groups most likely to benefit from the programs they are running, and to help policy makers understand which groups may need new approaches to help them move to work, stay at work, advance in their jobs, or help their children. The study will use data on nearly 100,000 individuals from 25 programs in 11 states, from MDRC experimental studies of welfare employment programs.

EXPECTED DATE OF COMPLETION:09/29/2002

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Alan Yaffe, 202-401-4537

PIC ID: 7532

PERFORMER: Manpower Demonstration Research Corporation, New York, NY

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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: John Maniha, 202-401-5372

PIC ID: 6821

PERFORMER: Illinois Department of Human Services, Springfield IL

Administration on Aging (AoA)

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'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.

EXPECTED DATE OF COMPLETION: 07/31/2001

AGENCY SPONSOR: Office of Assistant Secretary for Aging

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

PIC ID: 7296

PERFORMER: University of Kansas, Lawrence, KS

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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Office of Assistant Secretary for Aging

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

PIC ID: 7297

PERFORMER: University of Kansas, Lawrence, KS

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 famlies 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.

EXPECTED DATE OF COMPLETION:07/01/2003

AGENCY SPONSOR: Office of Assistant Secretary for Aging

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

PIC ID: 7298

PERFORMER: University of Kansas, Lawrence, KS

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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Office of Assistant Secretary for Aging

FEDERAL CONTACT: David Bunoski, 202-260-0669

PIC ID: 6855

PERFORMER: Westat, Inc., Rockville, MD

Agency for Healthcare Research and Quality (AHRQ)

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.

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 2000 Evaluation Reports

CONQUEST Evaluation: Final Report

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. The Agency for Healthcare Research and Quality (AHRQ) promotes CONQUEST as a tool for improving the quality of health care provided to the U.S. population through dissemination of the software. Its more immediate objectives are to improve the state of clinical performance measurement and to promote greater standardization in clinical performance measurement. This evaluation was requested by AHRQ to provide information on how CONQUEST 2.0 was being received and used by the audiences that the Agency had targeted and reached (e.g., health plans, health care providers, policy makers, employers, and other government agencies). The study found that at the time the survey was fielded, only about 10 percent of recipients were actually using CONQUEST. One of the barriers to use was that people did not have the time to learn how to use the software and many suggested that more than a brief demonstration and self-instructional materials need to be available if persons are to be encouraged to use the software. Other suggestions and recommendations include making the software a web-based operation, training for first-time users and developing a better description of what the CONQUEST software is and what it is not.

AGENCY SPONSOR: Center for Quality Measurement and Improvement

FEDERAL CONTACT: Marge Keyes, 301-594-1824

PIC ID: 7010

PERFORMER: Research Triangle Institute, Research Triangle Park, NC

Evaluation of the AHRQ Evidence-Based Practice Center (EPC) Reports: A Survey of Customers: Final Report

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. This project was an evaluation of these reports aimed at tracking the use and perceptions of the EPC products to improve future products from the program. The primary method used to study the EPC Program was a survey of collaborators to the Evidence-Based Practice Centers and of potential users. The organizations surveyed included quality improvement organizations, health care providers, health-related schools, health-related professional associations, government organizations, and government research agencies. The findings support and illustrate the usefulness in the reports and that the EPC program should continue to aim to produce high-quality comprehensive reviews on important clinical topics that lead to concise and clear results.

AGENCY SPONSOR: Center for Practice and Technology Assessment

FEDERAL CONTACT: Margaret Coopey, 301-594-4022

PIC ID: 7037

PERFORMER: Medstat Group, Washington, DC

Evidence Report and Synthesis on "The Effects of Credentialing on the Quality of Ultrasound Imaging Services

This study was undertaken to study the differences in quality between ultrasound services furnished by individuals who are credentialed versus those who are not. The study examined and evaluated difference in error rates, resulting complications, and patient outcomes to determine any quality differences that can be correlated with the differences in credentialing status. The researchers assessed a public meeting discussion on existing evidence of the effects of sonographer credentialing, conducted a preliminary literature review and examined the data collected and maintained by the two dominant sonographer credentialing organizations to conduct an analysis of credentialing effects on quality. The public meeting discussions and the literature review indicated very little evidence exists directly relating sonographer credentialing outcomes in a quantifiable meaningful fashion. Further, although the credentialing organizations maintain detailed information specific to sonographers, the amount of additional data required to control for other confounding factors that would ultimately affect the outcome of a particular course of treatment would require a fairly extensive research project, possibly including primary data collection. Based on the findings, the report recommends no further studies of this issue by AHRQ.

AGENCY SPONSOR: Agency for Healthcare Research and Quality

FEDERAL CONTACT: Harry Handelsman, 301-594-4025

PIC ID: 7477

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

Final Report on "Review of the Literature on Evaluations 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 the State Child Health Insurance Program (S-CHIP) and Medicaid programs. The literature review identifies and reviews nine published evaluations of outreach activities designed to increase awareness of, or enrollment in, public insurance programs. The review also identifies and describes 17 formal evaluations underway of outreach efforts to improve enrollment in Medicaid and SCHIP programs. The review found that rigorous evaluations of the types of outreach activities that are frequently considered to be more effective for overcoming barriers to enrollment in SCHIP, Medicaid, or other public insurance programs are largely absent from the published literature. Research is deficient with regard to outreach strategies targeting various subgroups of children, community variables that might facilitate or mitigate outreach strategies, and the cost-effectiveness of alternative approaches. The report concludes with options for prioritizing future research in this area.

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

Health Services Research Education: Assessing Customer Satisfaction and Program Needs

The goals of this project were to provide the Agency for Health Care Policy and Research (AHCPR) with information about present and anticipated needs in health services research training that are not currently being met or are only being met partially by the AHCPR-funded program; and An assessment of the level of satisfaction that past trainees from the institutionally-based health services research training program had with their experiences during training, and with the adequacy of these training activities relative to trainees' career expectations and requirements. The evaluation consisted of (1) a needs assessment for the national training program in health services research; and (2) an assessment of customer satisfaction among former trainees with the education, research, and mentoring features of this program. The assessments were focused on four broad areas of inquiry, which are: Infrastructure, Community, Visibility, and Future Directions. Focus group discussions were held among the key stakeholders of the training programs, other focus groups were conducted with program directors, program faculty, current trainees and employers of health services researchers, and a questionnaire was used to determine customer satisfaction with the trainee experience. Overall, respondents were satisfied with the quality of their training experience; 77 percent were satisfied with their program's visibility; large numbers were satisfied with many aspects of the infrastructure, the mentoring from the faculty, the duration of the stipend, and the academic programs: There was not, however, a strong sense of community among AHCPR trainees.

AGENCY SPONSOR: Agency for Healthcare Research and Quality

FEDERAL CONTACT: Debbie Rothstein, 301-594-2918

PIC ID: 7011

PERFORMER: Battelle Columbus Laboratories, Columbus, OH

Management Options for the Office of Priority Populations

Following the Congressional mandate stipulating that AHRQ establish an Office of Priority Populations (OPP) to conduct and support research, evaluations and demonstration projects, the Lewin Group was requested to develop a range of organizational and management options to establish that office. The goal of the OPP will be to determine the etiology of health disparities among priority populations and to provide solutions that will begin to close the gap. Priority populations include low income groups, minorities, women, children, elderly, those with special needs, and rural and inner-city persons. The Lewin Group conducted an extensive two-month review of AHRQ internal staff, agency representatives and external groups to propose a set of recommendations on the establishment of this new office. They recommend that the Office have a Director with a speciality in one of the priority areas and additional staff of 10 to 12 individuals. The Director shall have four persons reporting directly to his/her and who can address the crosscutting needs of rural, inner-city, special needs, and low-income sub-groups. The development of the OPP, they recommend, should focus on: strategic planning activities including identifying the vision, goals and objectives for priority populations research; infrastructure building focusing on development of internal and external communication channels; budget development; and staff development.

AGENCY SPONSOR: Agency for Healthcare Research and Quality

FEDERAL CONTACT: Wendy Perry, 301-594-2453

PIC ID: 7476

PERFORMER: Lewin Group, San Francisco, CA

Phase I of the Feasibility Study for Electronic Bulletin Board (EBB) to Promote Health Services Research Partnerships

The Agency for Healthcare Research and Quality (AHRQ) requested this study to determine, in Phase I, the feasibility of creating an electronic bulletin board (EBB) that would facilitate forming health services research partnerships. Phase II will occur only if the EBB should prove feasible. Through structured discussions with web managers of Internet sites and focus groups of health services researchers, it was found that there is little need for or desire to use the proposed EBB to facilitate the establishment of research partnerships at the present time. Informants indicated a preference for continuing to identify candidates for research partnerships through personal-professional networks or literature reviews. Alternatives that AHRQ may wish to consider that the report suggests might achieve some of the objectives of the proposed EBB are to: include the EBB as an application on an existing web site for health services research; develop and promote a listserv around partnership issues thereby creating a user community that is interested in the proposed EBB; develop a referral network with organizations that currently promote partnerships in health services research to broker those requests for partnerships coming to AHRQ; and compile and disseminate information about funding for health services research and promote the creation of more requests for applications and requests for proposals that require (and reward) the creation of partnerships.

AGENCY SPONSOR: Agency for Healthcare Research and Quality

FEDERAL CONTACT: Cindy Brach, 301-594-1824

PIC ID: 7404

PERFORMER: Battelle Corporation, Arlington, VA

ULP Program Evaluation: Final Report

The Agency for Healthcare Research and Quality (AHRQ), through its User Liaison Program (ULP), synthesizes and disseminates health care research results to State and local health policymakers in order to provide them with the "information and tools with which informed health policy decisions can be made." Among the "products" offered through ULP are two-and-a-half day policy-thematic workshops, somewhat longer skill-oriented workshops, and, more recently, somewhat briefer Masters Series seminars targeted to high-level policymakers, as well as written and electronic material. The primary goal of this evaluation was to demonstrate how participants used the information and materials they obtained at the workshops. The evaluation also examined whether or not ULP is appropriately targeted toward audiences most likely to use ULP products effectively. The evaluation had two components. First, an analysis of 1999 workshop participants to determine whether or not the workshops were attracting high-level participants. In the second part of the evaluation, phone interviews were conducted with 50 participants of 1999 workshops. The report found that respondents consider ULP workshops to be high-quality, informative, interactive learning events. Most respondents have used the information they gained at the workshop, either to enhance their knowledge base on health matters or in a direct application to their work. The complete final report can be found on the web at this address:

AGENCY SPONSOR: Agency for Healthcare Research and Quality

FEDERAL CONTACT: Steve Seitz, 301-594-2066

PIC ID: 7512

PERFORMER: Abt Associates, Inc., Cambridge, MA and Urban Institute, Washington, DC

In-Progress Evaluations

AHRQ Market Files: A Feasibility Study

In line with its new emphasis on special populations, including the disabled, AHRQ contracted to review the last ten years of Agency-funded work on individuals with disabilities to determine the areas of emphasis of the projects in order to assess the breadth and depth of the AHRQ disabilities-research portfolio.

EXPECTED DATE OF COMPLETION:09/15/2001

AGENCY SPONSOR: Center for Organization and Delivery Studies

FEDERAL CONTACT: Michael Hagan, 301-594-1354

PIC ID: 7484

PERFORMER: Center for Health Policy Studies, Columbia, MD

An Evaluation of Quality Measures and Timely and Cost Effective Strategies to Implement the Design Enhancements to the Medical Expenditure Panel Survey (MEPS)

The purpose of this project is to evaluate quality measures that should be added to the MEPS and to evaluate timely and cost effective strategies that implement design enhancements to the MEPS supportive of the Agency's national quality measurement initiative.

EXPECTED DATE OF COMPLETION:09/15/2001

AGENCY SPONSOR: Center for Organization and Delivery Studies

FEDERAL CONTACT: Thomas W. Reilly, 410-786-2196

PIC ID: 7401.2

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

Background Research in Support of the Development of an Institutional CAHPS Survey

The purpose of this project is to provide information that will assist in developing an institutional component to the Consumer Assessment of Health Plans (CAHPS) survey. CAHPS is a set of surveys that ask consumers about their experiences with their health plans. This project will conduct a review of the literature, identifying existing relevant surveys in the field and conducting and documenting a meeting of experts in the development and implementation of CAHPS surveys.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Center for Quality Measurement and Improvement

FEDERAL CONTACT: Charles Darby, 301-594-2050

PIC ID: 7493

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

Development of Point of Service Assessments for the Office of Management

This evaluation will be undertaken to develop point-of-service assessments for the Office of Management in the areas of personnel, administrative support, information technology, telecommunications, and contract general support services.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Agency for Healthcare Research and Quality

FEDERAL CONTACT: Barry Flaer, 301-594-1433

PIC ID: 7485

PERFORMER: Washington Consulting Group, Bethesda, MD

Empirical Analysis of a Guideline-developed Clinical Performance Measure - the Example of Pediatric Gastroenteritis Development

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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Center for Outcomes and Effectiveness Research

FEDERAL CONTACT: Steve Fox, 301-597-1485

PIC ID: 7037.1

PERFORMER: MEDSTAT Group, Cambridge, MA

 

Evaluation of Accounting and Financial Management Services

The contractor is to provide on an as needed basis, consulting services for accounting, auditing, financial reporting review, financial management, analysis, planning, performance measurement, and other related services.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Agency for Healthcare Research and Quality

FEDERAL CONTACT: Barry Flaer, 301-594-1433

PIC ID: 7487

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

Evaluation of Data Sources Used in Research on Health Care Markets

This report summarizes the findings of an effort to identify and describe data sources that can be used to conduct research on the characteristics of health care markets. The project was also undertaken to determine whether a comprehensive ongoing data system that describes health care markets can be constructed. To provide this information, the project conducted a literature review of health care market research and developed two data collection tools to ensure consistency and accuracy of the data collection. Because of their broad availability, the report recommends the use of both zip code level data sets and county level data to develop a data system that describes health care markets. The inventory of data sources undertaken in this project is the foundation for a more comprehensive feasibility study which should include an investigation of the possible uses for such a data system. Identification of the research questions to be answered by the system's data will be important for identifying the databases to be included in the system as well an investigation of data definitions to determine whether data sets are compatible when combined.

EXPECTED DATE OF COMPLETION:10/31/2001

AGENCY SPONSOR: Agency for Healthcare Research and Quality

FEDERAL CONTACT: Michael Hagan, 301-594-1354

PIC ID: 7402

PERFORMER: Center for Health Policy Research, Denver, CO

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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Agency for Healthcare Research and Quality

FEDERAL CONTACT: Michael Hagan, 301-594-1354

PIC ID: 7401

PERFORMER: Research Triangle Institute, Research Triangle Park, NC

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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Center for Practice and Technology Assessment

FEDERAL CONTACT: Margaret Coopey, 301-594-4022

PIC ID: 5955

PERFORMER: Lewin Group, San Francisco, CA

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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Center for Cost and Financing Studies

FEDERAL CONTACT: Debbie Rothstein, 301-594-2918

PIC ID: 7397

PERFORMER: Battelle Corporation, Arlington, VA

Improving the Process for Tracking Research Impact

This project will describe and analyze the methods used by other federal agencies to monitor the results and impact of the research they fund; to contrast it with ongoing AHRQ activities to achieve this purpose; and to present options for improving AHRQ activities consistent with AHRQ's level of resources.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Office of Health Care Information

FEDERAL CONTACT: Sandra Isaacson, 301-594-2067

PIC ID: 7494

PERFORMER: Lewin Group, San Francisco, CA

Review of Existing Reporting Systems to Inform the Development of the National Quality Report

The purpose of this contract is to do a comprehensive literature search, along with an Internet search, for information on quality reporting programs in the U.S. and internationally. That information will be analyzed to see if there are any common themes or best practices among other reporting entities which may serve to inform work on the National Quality Report.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Center for Quality Measurement and Improvement

FEDERAL CONTACT: Diana Dodd, 301-594-1543

PIC ID: 7491

PERFORMER: MEDSTAT Group, Cambridge, MA

Vision Rehabilitation within Models of Care and Benefit Plans

This project will review and synthesize the scientific literature over the past decade for advances in rehabilitation of patients with chronic impairments. (The focus vision impairment as an example, and on measures of improvement in functioning). To assess the rate and success of adoption of rehabilitation strategies in various delivery systems, as well as obstacles to successful adoption, within different models of medical practice and health benefit plans. To recommend next steps for AHRQ in building a research base to address the needs of private and public decision-makers on improving rehabilitation for chronic conditions, with specific application to vision impairments.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Center for Organization and Delivery Studies

FEDERAL CONTACT: Bernard Friedman, 301-594-6819

PIC ID: 7495

PERFORMER: Lewin Group, San Francisco, CA

Agency for Toxic Substances and Disease Registry (ATSDR)

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?

In-Progress Evaluations

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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Agency for Toxic Substances and Disease Registry

FEDERAL CONTACT: Maureen Orr, 404-639-6391

PIC ID: 6854.2

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

Centers for Disease Control and Prevention (CDC)

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 2000 Evaluation Reports

Assess Programs to Prevent Diabetic End-Stage Renal Disease

Diabetic end-stage renal disease (ESRD) is a serious and costly complication of diabetes. Renal protective benefits have been demonstrated for angiotensin converting enzyme (ACE) inhibitors, leaning the American Diabetes Association (ADA) to recommend that patients receive treatment with ACE inhibitors after the onset of microalbuminuria. The primary objective of this study was to evaluate the economic benefits of early, widespread treatment with ACE inhibitors for patients with Type 1 diabetes using a computer simulation model. The model developed for the study was based on the natural history of Type 1 diabetes. The model parameters were based on the findings from the major population surveys, clinical trials, and other clinical studies of individuals with diabetes as reported in the medical literature. The results show that the cost-effectiveness estimate from the base case analysis is at the high end of the acceptable range to support the strategy of early treatment with ACE inhibitors. The results also show that when good glycemic control is achieved and ACE treatment begins after onset of microalbuminuria, the lifetime incidence of diabetic ESRD is reduced from over 20% to a rate of under 2%. In addition, the estimated benefits of early ACE treatment are higher for patients who have an earlier age at onset for diabetes. This would suggest that children should be treated with ACE.

AGENCY SPONSOR: National Center for Chronic Disease Prevention and Health

Promotion

FEDERAL CONTACT: Stephen W. Sorenson, 770-488-1271

PIC ID: 7388

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

Assessment, Testing and Evaluation of Teen Pregnancy Prevention Interventions and Programs

This project was a study of issues surrounding the successful replication of effective approaches to teen pregnancy prevention. The main objective of the project was to develop a set of publication-ready guidelines for the replication of adolescent pregnancy prevention programs for use by local program implementers. The final report drew on the lessons learned by leaders in the adolescent pregnancy prevention field, including the program development and evaluation staff of the community demonstration teen pregnancy prevention programs funded by the Centers for Disease Control and Prevention (CDC) and other organizations. A core group of "key" elements surrounding successful efforts to replicate programs to prevent teen pregnancy emerged from data collection activities in this project, including: quality and attractiveness of the program being replicated; local context; organizational investment; financing; leadership; partnerships/collaborative efforts; fidelity of implementation and evaluation. Findings showed that program planners and implementers must address these key elements in each of three stages of development: preparation for the replication, implementation of the replication, and continuation/sustainability of the replication. Sustainability, for example, requires stable funding, local recognition of the program's value, ongoing support and continued recruitment to the local group of program champions.

AGENCY SPONSOR: National Center for Chronic Disease Prevention and Health

Promotion

FEDERAL CONTACT: Michael Dalmat, 404-488-5136

PIC ID: 6274.1

PERFORMER: Battelle Corporation, Arlington, VA

Development of an Evaluation System to Assess NIOSH's Health Hazard Evaluation Program

The National Institute for Occupational Safety and Health's (NIOSH's) Health Hazard Evaluation (HHE) program responds to approximately 450 requests for on-site health evaluations from various agencies per year. Each on-site evaluation report contains recommendations to address health hazards identified. This study's purpose was to determine if the report recommendations were implemented to reduce the hazards in a cost-effective manner. Through meetings with HHE staff and stakeholder interviews the study documented program strengths and accomplishments. There were a number of instances where HHE reports identified new hazards, initiated wider studies, and issued alerts resulting in regulatory or procedural changes that improved worker health and safety. Some reports lacked sufficient timeliness and the recommendations were impractical. The study findings suggest that NIOSH should regularly gather information about the implementation of HHE report recommendations, optimally with a telephone follow-up survey. In addition, NIOSH should develop an evaluation system to document the impact of HHE reports on reduction of health hazards.

AGENCY SPONSOR: National Institute for Occupational Safety and Health

FEDERAL CONTACT: David S. Sundin, 513-841-4382

PIC ID: 5922

PERFORMER: Research Triangle Institute, Research Triangle Park, NC

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. To address the problem CDC developed prevention guidelines in collaboration with the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) and published the guidelines in the Morbidity and Mortality Weekly Report in 1996. This evaluation assessed the management of GBS disease in the United States, looking at the extent to which the guidelines were followed and factors associated with poor compliance. Results showed that implementation of the new GBS prevention guidelines was successful at the test site (Group Health Cooperative of Puget Sound) and was accomplished in a short time period. More complete compliance with GBS guidelines helped to improve clinical outcomes for mothers with GBS infections. A cost benefit analysis showed that the costs of delivering antibiotics is minimal compared with the potential health and economic benefits from reduced infant mortality. This population-based evaluation is a good example of collaboration between managed care organizations and public health agencies to determine the impact of national disease prevention guidelines on health care providers.

AGENCY SPONSOR: National Center for Infectious Diseases

FEDERAL CONTACT: Anne Schuchat, 404-639-2215

PIC ID: 6333

PERFORMER: American Association of Health Plans, Washington, DC

Evaluation of NCIPC Injury Control Recommendations for Bicycle Helmets

In 1995, NCIPC published recommendations on the use of bicycle helmets in preventing head injuries, including information on the magnitude of related head injuries, potential impact of increased helmet use, helmet standards and crash performance, barriers to increased helmet use by the public, and approaches to increase community-level bicycle helmet use. The evaluation purpose was to measure effective use of the recommendations by NCIPC's injury prevention constituents (state and local health officials and national bicycle safety advocate organizations) and access the process of developing the recommendations. The study's survey of constituents showed that 90% of respondents found the recommendations useful for their efforts to increase bicycle helmet use, such as directing a bicycle helmet promotion program, advocating for a injury prevention program, and disseminating information to other injury prevention constituents. Eighty percent of respondents also said that CDC should develop additional recommendations to address prevention service problems. Survey results have helped CDC to improve the development and dissemination of recommendations.

AGENCY SPONSOR: National Center for Injury Prevention and Control

FEDERAL CONTACT: Jeffrey Sacks, 770-488-4652

PIC ID: 6700

PERFORMER: Battelle Corporation, Arlington, VA

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

The National Telecommunications System for Surveillance (NETSS) is a computerized public health surveillance system that assembles, analyzes and disseminates weekly data on about 50 nationally notifiable diseases, provided by state and territorial health agencies and transmitted to CDC's Epidemiology Program Office (EPO). Providers, clinical laboratories, and public health officials collect NETSS data at the state and local level. The evaluation purpose was to examine the effective use of communicable disease data transmitted to CDC over NETSS by state and local public health officials, as well as CDC officials. In addition, the study sought to identify barriers to effective use and ways to make improvements. State officials responding to a national survey said they are making effective use of NETSS data to track trends in communicable diseases, detect epidemiological patterns, and compare observed levels of disease to expected levels. Technical barriers to the use of NETSS data were mentioned in open-ended comments on surveys and in all focus groups. Major problems cited have to do with outdated computer technology or incompatibilities with other electronic disease surveillance systems, including unresolved software malfunctions. The state epidemiologies recommended that disease data from other states be available for analysis.

AGENCY SPONSOR: Epidemiology Program Office

FEDERAL CONTACT: Roy Baron, 404-639-2697

PIC ID: 6332

PERFORMER: Battelle Corporation, Arlington, VA

Evaluation of the ZAP Asthma Program

ZAP Asthma is a public-private partnership in Atlanta to decrease asthma morbidity and mortality in the Atlanta Empowerment Zone by demonstrating the effectiveness of environmental control and health education strategies, such as use of community health workers, public/private collaboration, and systems improvement and capacity building. The evaluation found program stakeholders and participants to have mixed opinions about the success of the program in achieving community collaboration and capacity building goals. The study conclusions identified barriers to successful implementations, such as the demands of the program's science protocol (impact of program on health of target families), the environmental focus of the strategies, unmet commitments, and inadequate funding. ZAP Asthma did demonstrate successfully with qualitative data that community health workers can engage and assist families with the care of their children with asthma . The results of the science protocol will be presented in a subsequent report. The evaluation report contains recommendations for addressing the implementation challenges faced by ZAP Asthma in Atlanta for future replications.

AGENCY SPONSOR: National Center for Environmental Health

FEDERAL CONTACT: James Rifenburg, 770-488-7322

PIC ID: 7048

PERFORMER: Macro International, Inc., Atlanta, GA

Final Report: CDC/Teutsch Fellowship Program Marketing

The Nixon Group was contracted by the partnership for Prevention and the Centers for Disease Control and Prevention to conduct audits to determine the direction for future marketing efforts for the Prevention Effectiveness Fellowship Program (CDC/Teutsch Fellowship Program). These audits included interviews with past fellows, current fellows, and prospective fellows. The information obtained from these audits enabled the Nixon Group to discover a series of key insights about how the various audiences view the fellowship and CDC and to suggest marketing strategies and tactics for the future. One suggestion called for nurturing and maintaining relationships with professors in the academic community Other insights included the ability to link the fellowship opportunity directly to university websites and specific graduate programs. Based on stakeholder audits and research, The Nixon Group determined it would be appropriate to develop a glossy, vibrant brochure to communicate the benefits of the fellowship and allow it to stand out from its competitors. Finally, The Nixon Group determined that preparing fellows to conduct fellow-to-fellow recruitment would be an essential aspect of the future marketing campaign

AGENCY SPONSOR: Epidemiology Program Office

FEDERAL CONTACT: Mark Messonnier

PIC ID: 7431

PERFORMER: The Nixon Group, Miami, FL

Formative Research on the Community Guide to Preventive Services

The U.S. Public Health Service commissioned a Task Force on Community Preventive Services to develop a Guide to Community Preventive Services (the Community Guide). The Guidel summarizes what is known about the effectiveness of population-based interventions for prevention and control. The Centers for Disease Control and Prevention (CDC), in an effort to create greater access to the Guide, developed an online version. The primary target audience will be people involved in the planning, funding, and implementation of population-based services and policies to improve health at the community and state levels. This project's goal was to interview potential members of the target audience after they reviewed the Guide's web site and ask them to provide feedback as to its usefulness to them and their organization and the types of information they hoped to glean from the web site. The majority of interviewees rated the web site an 8, 9 or 10 (very helpful) with an average of 8.2 because of its easy navigation, event listing, and the search function. Most respondents found the site useful, informative, and easy to use. The features of the site, such as the search function and the searchable databases, most found very helpful and useful. The features most would like to see added to the site included an alerts of updates; direct links to other web sites within chapters; and direct links to journals for references.

AGENCY SPONSOR: Public Health Practice Program Office

FEDERAL CONTACT: Pomeroy Sinnock, 770-488-2469

PIC ID: 7043

PERFORMER: Mathematica Policy Research, Inc., Princeton, NJ

Guide to Assessing Linkages Between Comprehensive HIV Prevention Plans and HIV Prevention Programs

HIV prevention community planning, implemented in January 1994, represented a major policy change in CDC requirements of health departments seeking financial assistance from CDC for HIV prevention. Prior to the change, the majority of federal funds available to the 65 health department recipients of CDC HIV prevention funding (under program announcement 300) were for HIV counseling and testing services. Now, via the HIV prevention community planning process, recipients set their own priorities which they document in a Comprehensive HIV Prevention Plan. Activities carried out under this study include technical and expert assistance through the pilot testing, by State and local health department grantees, of tools and a methodology for monitoring the implementation of their Comprehensive HIV Prevention Plan. The system to be pilot tested is based on a set of management and operational indicators developed over the past year. This system is intended to provide a measurable overview of how community planning is impacting HIV prevention programs. the Contractor is requested to support the pilot test (1) by preparing the pilot test sites to field test the tools and methods; (2) by refining the methods, tools, and associated indicators, based on the experience of the pilot sites; (3) by participating in the analysis and interpretation of the collected data; (4) by documenting the changes made to the methods, tools, and associated indicators; and (5) by developing recommendations for broader implementation of the tools and methods.

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

FEDERAL CONTACT: Robert D. Moran, 770-639-0952

PIC ID: 5518

PERFORMER: Macro International, Inc., Atlanta, GA

Missed Opportunities for Pneumocystis Carinii Pneumonia Prevention: Failure to Adhere to Usphs PCP Prophylaxis Guidelines and Epidemiology of Pcm Among Puerto Ricans with HIV Infection

This study explores individual and social factors associated with patients' decision to initiate and adhere to HIV treatment regimens and Prophylaxis for Pneumocystis carinii (PCP). Data was collected from HIV patients from three Community-Based Organizations (CBO's) and Women of HIV Clinic at San Juan, Puerto Rico. A Focus Group interview was utilized to collect the informations. Questions included information about knowledge, experiences, opinions and recommendations about HIV medical treatments and prevention of PCP. The mean age of participants was 36.9 with a diagnosis ranging from 1985 to 1999. The majority of participant (57%) reported receiving public assistance as a main source of income and most had completed high school and reported "some years of college"(66%). There have been several medical treatments developed to improve the quality of life for people living with HIV. Participants reported they had full knowledge of the latest modalities of treatments and most were excited about the availability of antiretroviral therapy but not all were currently utilizing the antiretroviral regiments. One important concern to participants is the side effects such as severe gastritis, kidney problems, diahrrea, nausea, and anemia. The principal reasons identified by the participants for taking treatments as prescribed were: accessibility, medicine free of charge, positive medication results, confidentiality, family support, co-worker support and after work services offered by clinic's staff, and participation in CBO's programs.

AGENCY SPONSOR: National Center for Infectious Diseases

FEDERAL CONTACT: Vance Dietz, 770-488-7771

PIC ID: 6704

PERFORMER: University of Puerto Rico Medical Services, San Juan, Puerto Rico

Phase III: National Physician Survey of STD Diagnosis, Treatment and Control Practices: Data Collection Final Report

The purpose of this study was to provide baseline information on current physician practices relating to STD diagnosis, treatment and control practices including partner management and notification. The STD contact survey was designed collaboratively by Battelle and CDC researchers. The objective was to provide baseline data necessary to characterize infection control practices, especially partner notification practices, for syphilis, gonorrhea, HIV, and chlamydia, and to measure the contextual factors that influence those practices. The data will help CDC to better focus STD control and partner notification program efforts and to allocate program resources. Battelle and CDC collaborated in designing the 21- page survey instrument; five medical specialties were selected for the survey based on evidence that they account for 85% of STDs diagnosed in the US; surveys were sent to a randomly selected sample of 7,300 physicians from the American Medical Association's Physician Master File. Physicians were selected who specialized in obstetrics/gynecology, internal medicine, general or family practice, emergency medicine, or pediatrics; who spent at least 50% of their professional time in direct care; and cared for patients between the ages of 13 and 60. Completed surveys were received from 4,226 physicians. This project comprised the data collection phase of this research project. Subsequent reports will provide results of the survey.

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

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

PIC ID: 6711

PERFORMER: Battelle, Seattle, WA

Report of the Panel to Evaluate the U.S. Standard Certificates and Reports

The National Vital Statistics System represents the Nation's capacity to collect data and maintain statistics on birth, deaths, fetal deaths, marriages, and divorces. These data come from State vital registration systems where standardize certificates are filed. The evaluation purpose was to assess current certificates for usefulness and quality for statistical and legal purposes; identify unmet data needs and determine whether the standard certificates should be changed; make recommendations for a standard vital statistics data base. Based on survey data from State vital registration and statistics executives and representative national health organizations and the work of an expert panel, the study found that substantial changes were needed for the standard birth certificate, particularly the medical portion. Additional data items are needed on the mother's health which could linked to other health data sources. Changes were also recommended for the standard certificates on death and fetal deaths to include data items that could permit linkages to other health data systems and would improve the quality of "cause-of-death" data.

AGENCY SPONSOR: National Center for Health Statistics

FEDERAL CONTACT: Julia Kowaleski, 301-436-8815

PIC ID: 6699

PERFORMER: Laurel Consulting Group, Laurel, MD

The Development of Community Indicators for Assessing HIV Prevention Activities

This study was conducted by Macro International for the Centers for Disease Control and Prevention (CDC) to assess the cumulative effects of HIV prevention efforts within a given jurisdiction. Within each of the 65 jurisdictions that CDC supports for HIV prevention, there is an array of interventions for each target population that, when combined, are expected to result in changes in the determinants of HIV risk behaviors and HIV transmission. These HIV Prevention Indicators (HPI) are designed to monitor the key biological, behavioral, socio-political, and service-related "vital signs" of the four primary HIV sub- epidemics and prevention activities at this level. The main intended audience for these indicators is public health officials and HIV prevention community planning groups at the state and local levels. In addition, CDC must also be able to describe and assess the national status of HIV prevention to help guide national policies and programs. Meeting the needs of both these audiences requires a standard set of core indicators that can be addressed with data uniformly available across the country. Thus, the indicators found in this document are limited to those for which data are currently available for at least half of CDC's HIV prevention grantees.

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

FEDERAL CONTACT: Deborah Rugg, 404-639-0952

PIC ID: 6707

PERFORMER: Macro International, Inc., Atlanta, GA

In-Progress Evaluations

Assessment of Core Public Health Surveillance and Response Capacity for Addressing Food Borne Diseases, Bioterrorism, and Other Infectious Threats

The purpose of this project is to begin the process of developing a consensus definition of core capacities for infectious disease surveillance starting with public health laboratories. A contractor will be hired to develop and pilot test a methodology for assessing necessary public health laboratory capacities and capabilities for select infectious diseases. For the purposes of this proposal, capacity refers to the output of testing or services accomplished over a defined time period; capability refers to a specific activity that will ensure the laboratory's success in conducting infectious disease surveillance.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: National Center for Infectious Diseases

FEDERAL CONTACT: Deborah Deppe, 404-639-4668

PIC ID: 7436

PERFORMER: Research Triangle Institute, Research Triangle Park, NC

Assessments of Immunization-Related Knowledge, Attitudes, and Practices of Primary Care Physicians in the U.S.

The Vaccines for Children (VFC) program is a state-operated, federal entitlement program that supplies private and public providers with federally purchased vaccine. This process evaluation of the VFC program allowed the assessment, in a single state, South Carolina, of how many VFC-eligible children are receiving immunizations in HD immunization-only clinics and of factors associated with use of these clinics. The objective was to determine the factors associated with seeking immunizations in health department clinics throughout the state. Research Triangle Institute (RTI) was contracted by the Centers for Disease Control and Prevention (CDC) to interview the primary caretakers of children age 12 and under who bring their children to a health department clinic in South Carolina for immunizations. RTI conducted 706 interviews at 24 randomly selected clinics throughout the state. Data were collected via paper and pencil surveys. It was found that data collection procedures in South Carolina appear to have consider applicability to other states interested in client participation in the VFC program. Active involvement by the staff of the Department of Health played an important part in the success of the survey. The survey was well accepted; it received a 99 percent response rate, and it yielded information about program participants that is proving useful for planning.

EXPECTED DATE OF COMPLETION:12/30/2000

AGENCY SPONSOR: National Immunization Program

FEDERAL CONTACT: Nancy Cheal, 404-639-7095

PIC ID: 7197.1

PERFORMER: Research Triangle Institute, Research Triangle Park, NC

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.

EXPECTED DATE OF COMPLETION:10/01/2001

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

FEDERAL CONTACT: Esther Sumartojo, 404-639-8300

PIC ID: 6701

PERFORMER: Macro International, Inc., Atlanta, GA

Coordinated Evaluation of Tobacco Control Efforts

An increased level of scrutiny by the Department of Health and Human Services (HHS) has been directed at evaluating the overall impact and the relative cost-effectiveness of tobacco control programs. This project will focus on activities related to implementing a comprehensive and coordinated evaluation of Statewide tobacco control efforts.

EXPECTED DATE OF COMPLETION:01/03/2000

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

FEDERAL CONTACT: Don Sharp, 770-488-5703

PIC ID: 6714

PERFORMER: Battelle Corporation, Arlington, VA

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.

EXPECTED DATE OF COMPLETION:09/01/2000

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

FEDERAL CONTACT: Ruth Irwin, 404-639-8956

PIC ID: 7047

PERFORMER: The HMO Group, New Brunswick, NJ

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 objective of this project was 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. This final report presents three studies that use an alternative approach to assess the degree of Medicaid underreporting. In Studies 1 and 3, state administrative records were used to create sampling frames consisting of children currently enrolled in Medicaid. In Study 2, data on children selected during a random-digit-dial (RDD) telephone survey were linked back to state Medicaid enrollment records. This paper focused on the magnitude and effect of an underreporting bias and on the difficulties encountered when trying to link telephone surveys and administrative records. The study found that reporting of Medicaid coverage in population-based surveys is lower than the number of persons enrolled in Medicaid according to administrative data. Many health care research experts suspect that about 20% of the parents of Medicaid recipients do not report that their children receive Medicaid. And, linking survey respondents to Medicaid records will be hampered by difficulties in connecting focal children with enrollment lists and records.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: National Center for Health Statistics

FEDERAL CONTACT: Marcie Cynamon, 301-436-7085

PIC ID: 7046

PERFORMER: Robert Wood Johnson Foundation, Princeton, NJ

Evaluation of Non-Response to NHANES

The objective of this study is to reduce non-response bias in the National Health and Nutrition Examination Survey (NHANES). The central foci of this program assessment are the conduct of interviews and/or focus groups of respondents and non-respondents and potentially of individuals as similar to the non- respondents as possible to evaluate potential reasons for response and non-response to the NHANES.

EXPECTED DATE OF COMPLETION:09/30/2002

AGENCY SPONSOR: National Center for Health Statistics

FEDERAL CONTACT: David Davis, 404-639-0938

PIC ID: 7435

PERFORMER: Research Triangle Institute, Research Triangle Park, NC

Evaluation of Public Health Care Providers Training, Screening and Referral Practices for Pregnancy-Related Violence

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.

EXPECTED DATE OF COMPLETION:09/30/2001

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

FEDERAL CONTACT: Alison Spitz, 770-488-5260

PIC ID: 6712

PERFORMER: Battelle Corporation, Arlington, VA

Evaluation of Standing Orders in Nursing Homes

The purpose of this evaluation is to identify the costs of implementing standing orders programs and their components compared to other organized immunization programs in long term care facilities (LTC) and, subsequently, to determine the cost-effectiveness of such programs and their components. This evaluation will require two phases: Phase 1 will include identification of program costs and of effects of program on staff and resident flow at the LTC and, Phase 2 will include determination of cost effectiveness of the programs related to improvement in vaccination coverage rates in the LTC.

EXPECTED DATE OF COMPLETION:09/30/2002

AGENCY SPONSOR: National Immunization Program

FEDERAL CONTACT: Abigail Shefer, 404-639-8333

PIC ID: 7434

PERFORMER: Research Triangle Institute, Research Triangle Park, NC

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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: National Center for Health Statistics

FEDERAL CONTACT: Ann Hardy, 301-436-7085

PIC ID: 7040

PERFORMER: TRW Government Information Services, Fairfax, VA

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.

EXPECTED DATE OF COMPLETION:09/11/2001

AGENCY SPONSOR: Epidemiology Program Office

FEDERAL CONTACT: Dennis Jarvis, 404-639-4087

PIC ID: 7038

PERFORMER: Macro International, Inc., Atlanta, GA

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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: National Immunization Program

FEDERAL CONTACT: John Stevenson, 404-639-8730

PIC ID: 6713

PERFORMER: Advanced Technology Systems, Johnson City, TN

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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: National Center for Environmental Health

FEDERAL CONTACT: Margaret Watkins, 770-488-7187

PIC ID: 7042

PERFORMER: Battelle Corporation, Arlington, VA

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.

EXPECTED DATE OF COMPLETION:09/30/2001

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

FEDERAL CONTACT: Dara Murphy, 770-488-5046

PIC ID: 7051

PERFORMER: Macro International, Inc., Atlanta, GA

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.

EXPECTED DATE OF COMPLETION:09/30/2001

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

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

PIC ID: 7054

PERFORMER: Battelle Corporation, Arlington, VA

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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Public Health Practice Program Office

FEDERAL CONTACT: Pomeroy Sinnock, 770-488-2469

PIC ID: 6276

PERFORMER: Macro International, Inc., Atlanta, GA

Centers for Medicare and Medicaid Services (CMS)

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 Centers for Medicare and Medicaid Services (CMS), 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 CMS' 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—CMS 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—CMS’ 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 performancOutcomes, Quality and Performance<
  • 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—CMS’ research budget supports a variety of activities to increase the efficiency of our research and demonstration program and meet the crosscutting research needs of CMS and the wider health research community.

Fiscal Year 2000 Evaluation Reports

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: Beth Benedict, 410-786-7724

PIC ID: 7192

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

Decision Making in Managed Care Organizations: Implications for the Development and Diffusion of New Technologies

This project examined 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. Regarding Managed Care Organizations (MCOs), most stress the clinical orientation of their technology assessment process and assert that cost is very rarely an explicit consideration. Price is more often a factor in setting drug formularies and all plans indicated they would not refuse to cover a technology that had been generally accepted as the standard of care, no matter how expensive. The report found no evidence of an important independent effect of Medicare managed care among either MCOs or manufacturers. MCOs generally set uniform coverage policies for their Medicare and commercial products. The conclusions are: while managed care plans do attempt to control use of certain technologies, their ability to do so is restricted. Also, while managed care influences manufacturer R&D investment decisions, it is not clear that it has changed the likelihood that cost-increasing technologies will come to market, nor has it altered the fundamental feedback relationship between insurance, technological innovation, and health care expenditure growth.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Brigid Goody, 410-786-6640

PIC ID: 7170

PERFORMER: Health Economics Research, Inc., Waltham, MA

Economic Costs of ESRD

The recent structure of the U.S. Renal Data System (USRDS) has been marked by significant changes. In 1999 the USRDS was divided into a Coordinating Center (CC) and four Special Studies Centers (SSCs). In addition, alterations have been made to the focus, format, and appearance of the report. This 2000 ADR presents data on End Stage Renal Disease (ESRD) patients through 1998, the most recent year for which complete data is available. Users of the USRDS website can access PDF files of the printed Annual Data Reports (ADR), Reference Tables, and Researcher's Guide, download aggregate data and USRDS slides for use in their own analyses and presentations, and correspond with USRDS staff. Most of the data sets used by the USRDS are provided by CMS. Data are also obtained from the United Network for Organ Sharing (UNOS) and from the National Surveillance of Dialysis-Associated Diseases in the U.S., compiled by the Centers for Disease Control and Prevention (CDC). The structure of the USRDS database is illustrated in Figure i.w, and detailed descriptions of the database itself and of the methods used to work with and analyze the data are provided in Appendix A.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Joel Greer, 410-786-6695

PIC ID: 7198.2

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

Health Care Financing, Research Report: End Stage Renal Disease, 1993-95

The Centers for Medicare and Medicaid Services (CMS) is charged with the effective administration of Medicare benefits to eligible persons with end stage renal disease (ESRD). Integral to the effective management of the ESRD program is the operation of a comprehensive data base covering medical and demographic information for the Medicare ESRD population. This data base, along with other ESRD program-related data, is contained within the ESRD Program Management and Medical Information System (PMMIS). CMS recognizes the need to disseminate the information developed from the ESRD PMMIS data and any resulting analyses of these data. This report presents statistics concerning recent trends in ESRD treatment and detailed discussions of selected health issues involving the ESRD population. Several of the tables in this report emphasize trends and comparisons over time, making this report a standard reference on the Medicare ESRD population and on ESRD treatment patterns. Data released to CMS from other organizations have been included and identified where appropriate.

AGENCY SPONSOR: Centers for Medicare and Medicaid Services

FEDERAL CONTACT: Joel Greer, 410-786-6695

PIC ID: 7182

PERFORMER: The Lewin Group, Fairfax, VA

In-Progress Evaluations

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.

EXPECTED DATE OF COMPLETION:03/02/2002

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Victor McVicker, 410-786-6681

PIC ID: 7171

PERFORMER: Rand Corporation, Santa Monica, CA

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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Joel Greer, 410-786-6695

PIC ID: 7198

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

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

The Center for Medicare and Medicaid Services's (CMS'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 CMS's facility performance monitoring.

EXPECTED DATE OF COMPLETION:09/29/2003

AGENCY SPONSOR: Office of Clinical Standards & Quality

FEDERAL CONTACT: Sue Nonemaker, 410-786-6825

PIC ID: 7177

PERFORMER: Research Triangle Institute, Research Triangle Park, NC

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. CMS 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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Sherry Terrell, 410-786-6601

PIC ID: 7168.1

PERFORMER: Research Triangle Institute, Research Triangle Park, NC

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.

EXPECTED DATE OF COMPLETION:05/15/2003

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Ann Meadow, 410-786-6602

PIC ID: 7173

PERFORMER: University of Wisconsin, Madison, WI

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 Center for Medicare and Medicaid Services 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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Center for Beneficiary Choices

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

PIC ID: 7181

PERFORMER: Health Economics Research, Inc., Waltham, MA

Evaluation of High Risk Pools

As a method of assuring availability of insurance in the individual market, the Health Insurance Portability and Accountability Act (HIPAA) alows the use of an acceptable State alternative mechanism in placeof adopting precise HIPAA provisions. One of these accceptable mechanisms is to use a State's High-Risk Pool for HIPAA eligibles. Since the statutory objective of this acceptable mechanism is to guarantee the availability of insurance to individuals, the goal of this project will be to evaluate the best standards for a High Risk Pool to be sustained and to remain an acceptable alternative mechanism for HIPAA eligibles. This project will summarize and detail the similarities and differences between risk pools in the context of the dynamics in individual insurance law for States which have accepted these risk pools as alternative mechanisms.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Center for Medicaid & State Operations

FEDERAL CONTACT: James Fuller, 410-786-3365

PIC ID: 7422

PERFORMER: Abt Associates Inc., Cambridge, MA

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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Office of Strategic Planning

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

PIC ID: 6166

PERFORMER: Health Economics Research, Inc., Waltham, MA

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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Ann Meadow, 410-786-6602

PIC ID: 7203

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

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.

EXPECTED DATE OF COMPLETION:12/14/2002

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Noemi Rudolph, 410-786-6662

PIC ID: 7390

PERFORMER: Health Economics Research, Inc., Waltham, MA

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.

EXPECTED DATE OF COMPLETION:07/13/2004

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Rose Marie Hakim, 410-786-6698

PIC ID: 7380

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

Evaluation of the Community Nursing Organization 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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: James Hawthorne, 410-786-6689

PIC ID: 6306.1

PERFORMER: Abt Associates Inc., Cambridge, MA

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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Penny Pine, 410-786-7718

PIC ID: 6288

PERFORMER: Research Triangle Institute, Research Triangle Park, NC

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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: John Robst, 410-786-1217

PIC ID: 7185

PERFORMER: University of Minnesota, Minneapolis, MN

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.

EXPECTED DATE OF COMPLETION:03/29/2002

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Susan Radke, 410-786-4450

PIC ID: 7208

PERFORMER: The Lewin Group, Fairfax, VA

 

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.

EXPECTED DATE OF COMPLETION:09/27/2003

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Renee Mentnech, 410-786-6692

PIC ID: 7172

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

Evaluation of the Medicare Choice Demonstration

TheMedicare Choice Demonstration tests 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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Renee Mentnech, 410-786-6692

PIC ID: 6292

PERFORMER: Mathematica Policy Research, Inc., Plainsboro, NJ

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.

EXPECTED DATE OF COMPLETION:09/29/2004

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: William Buczko, 410-786-6593

PIC ID: 7379

PERFORMER: Health Economics Research, Inc., Waltham, MA

Evaluation of the Nursing Home Case-Mix and Quality Demonstration

This project will help the CMS 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.

EXPECTED DATE OF COMPLETION:09/01/2001

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Edgar Peden, 410-786-6594

PIC ID: 6307

PERFORMER: Abt Associates Inc., Cambridge, MA

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.

EXPECTED DATE OF COMPLETION:09/14/2001

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Penny Pine, 410-786-7718

PIC ID: 7184

PERFORMER: Health Economics Research, Inc., Waltham, MA

Evaluation of the State Health Reform Demonstrations

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.

EXPECTED DATE OF COMPLETION:09/30/2002

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Penny Pine, 410-786-7718

PIC ID: 6289.1

PERFORMER: Urban Institute, Washington, DC

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.

EXPECTED DATE OF COMPLETION:09/15/2001

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Brigid Goody, 410-786-6640

PIC ID: 7169

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

Health Disparities: Longitudinal Study of Ischemic Heart Disease Among Aged Medicare Beneficiaries

This project assesses the use of Medicare covered services among Medicare beneficiaries with ischemic heart disease based on sociodemographic characteristics (e.g., race/ethnicity, sex, age, socioeconomic status). It is one part of a larger CMS and Department of Health and Human Services effort to address health disparities among Medicare beneficiaries. This will be done using a longitudinal database that links Medicare enrollment and claims data with small-area geographic data on income (e.g., U.S. Census data) Due to recent change in the race/ethnic coding in the Medicare enrollment database (EDB), it is not possible to examine health care access, utilization, and outcomes among minority groups.

EXPECTED DATE OF COMPLETION:01/21/2002

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Linda Greenberg, 410-786-0677

PIC ID: 7419

PERFORMER: Health Economics Research, Inc., Waltham, MA

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.

EXPECTED DATE OF COMPLETION:02/28/2002

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Penny Pine, 410-786-7718

PIC ID: 7183

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

Maximizing the Cost Effectiveness of Home Health Care (HHC)

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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Ann Meadow, 410-786-6602

PIC ID: 7179

PERFORMER: Center for Health Policy Research, Denver, CO

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 Centers for Medicare and Medicaid Services's (CMS'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.

EXPECTED DATE OF COMPLETION:09/28/2002

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Joel Greer, 410-786-6695

PIC ID: 6303

PERFORMER: Center for Health Policy Research, Denver, CO

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.

EXPECTED DATE OF COMPLETION:05/31/2002

AGENCY SPONSOR: Office of Clinical Standards & Quality

FEDERAL CONTACT: Mary Pratt, 410-786-6867

PIC ID: 7176

PERFORMER: University of Minnesota, Minneapolis, MN

Medicare Post-Acute Care: Evaluation of BBA Payment Policies and Related Changes

The purpose of this project is to study the impact of the Balanced Budget Act (BBA) and other policy changes on Medicare utilization and delivery patterns of post-acute care. Post-acute care is generally defined to include the Medicare covered services provided by skilled nursing facilitie s(SNFs), home health agencies, rehabilitation hospitals and distinct part units, long term care hospitals, and outpatient rehabilitation providers. Understanding the relationships among post-acute care delivery systems is critical to the development of policies that encourage appropriate and cost-effective use of the entire range of care settings. The results of this work may be useful in refining policies for individual types of post- acute care, as well as in developing a more coordinated approach across all settings.

EXPECTED DATE OF COMPLETION:09/20/2002

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Philip G. Cotterill, 410-786-6598

PIC ID: 7417

PERFORMER: Medstat Group, Washington, DC

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.

EXPECTED DATE OF COMPLETION:09/29/2005

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Noemi Rudolph, 410-786-6662

PIC ID: 7186

PERFORMER: University of Minnesota, Minneapolis, MN

NAS/Institute of Medicine Study (IOM) 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.

EXPECTED DATE OF COMPLETION:02/28/2002

AGENCY SPONSOR: Office of Clinical Standards & Quality

FEDERAL CONTACT: Kathy Pirotte, 410-786-6774

PIC ID: 7174

PERFORMER: National Academy of Sciences, Washington, DC

Normative Standards for Medicare Home Health Utilization

This task order develops 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.

EXPECTED DATE OF COMPLETION:09/24/2001

AGENCY SPONSOR: Office of Clinical Standards & Quality

FEDERAL CONTACT: Mary Wheeler, 410-786-6892

PIC ID: 7175

PERFORMER: Center for Health Policy Research, Denver, CO

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 Centers for Medicare and Medicaid Services (CMS), and www.healthfinder.gov, which was developed by the Office of Disease Prevention Health Promotion in collaboration with other agencies.

EXPECTED DATE OF COMPLETION:04/30/2002

AGENCY SPONSOR: Center for Beneficiary Choices

FEDERAL CONTACT: Barbara Crawley, 410-786-6590

PIC ID: 7212

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

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

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.

EXPECTED DATE OF COMPLETION:09/29/2002

AGENCY SPONSOR: Center for Medicaid & State Operations

FEDERAL CONTACT: David Greenberg, 410-786-2637

PIC ID: 6310

PERFORMER: Abt Associates Inc., Cambridge, MA

Racial Disparities in Health Services Among Medicaid Pregnant Women (Multi- State) Analysis

This is a study of associations between pregnancy-related care and outcomes, and the ethnic and racial characteristics of women who had a Medicaid covered delivery during calendar year 1995. This study is expected to identify and explain the patterns of disparities in prenatal and postpartum care and outcomes provided to Medicaid women. The project will evaluate the use of health services from entry into prenatal care through the delivery and into the first three postpartum months. The CMS eligibility and utilization data contain information on racial and ethnic minority groups. These data include diagnoses, procedures, date and type of delivery, reimbursements, demographics, and geographic location. The study will examine the use of and Medicaid expenditures for health services from the initial prenatal care visit through the delivery and into the first three postnatal months. specific prenatal care markers to be considered include delayed prenatal care, no prenatal care, and an insufficient total number of prenatal care visits for a full-term, normal pregnancy.

EXPECTED DATE OF COMPLETION:09/30/2002

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Beth Benedict, 410-786-7724

PIC ID: 7416

PERFORMER: Research Triangle Institute, Research Triangle Park, NC

Survey of Medicare Beneficiaries Who Were Involuntarily Disenrolled from HMOs that Withdrew from Medicare

When HMOs withdraw from the Medicare program or reduce their service areas, thousands of Medicare beneficiaries become disenrolled involuntarily each year. There has, therefore, been concern among policymakers about the impact of the recent HMO withdrawals on the beneficiary population. CMS anticipates that additional withdrawals may occur in 2001 and subsequent years. It is desirable to know the impact on beneficiaries if a significant number of additional withdrawals occurs in 2001. This project will conduct a survey that asks about the experience of beneficiaries whose plans withdraw from Medicare or reduce their service areas in January 2001. the universe from which the survey sample will be drawn is the Medicare population enrolled in managed care plans taht either terminate their risk contracts or reduce their service areas in January 2001. They survey will be conducted by mail with telephone followup, and will consist of 20-30 questions.

EXPECTED DATE OF COMPLETION:02/28/2002

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Gerald Riley, 410-786-6699

PIC ID: 7421

PERFORMER: University of Wisconsin, Madison, WI

Food and Drug Administration (FDA)

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

Evaluation Program

The Food and Drug Administration’s FY 2000 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. HHS’s 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 FDA’s dynamic environment. FDA’s challenges, now and in the future, will rest on its ability to leverage its 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 2000 Performance Report, are one indication of how well FDA is meeting its goal of making timely pre-market review decisions. The focus of performance goals under PDUFA 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 2000 Evaluation Reports

Consumer Attitudes Toward Potential Changes in Food Standards of Identify - Vol. 1: Final Report

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 these 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 of 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 that particular standards 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: Clark Nardinelli, 202-205-8702

PIC ID: 6865

PERFORMER: Research Triangle Institute, Research Triangle Park, NC

Dietary Supplement Sales Information: Final Report

FDA needs sales information on dietary supplements in order to perform its regulatory mission under the Dietary Supplement Health and Education Act of 1994 (DSHEA). Provisions of DSHEA define dietary supplements and ingredients and set forth new labeling requirements whereby manufacturers must notify FDA of new dietary ingredients prior to marketing. Under the DSHEA, the Secretary of Health and Human Services is authorized to regulate dietary supplements and to prescribe good manufacturing practices (GMPs) for the industry. FDA contracted with RTI to conduct a survey on dietary supplement products according to a statistical sampling plan and to provide a database containing information on dietary supplement products. The report entitled Dietary Supplement Sales Information documents the procedures used to select a sample of approximately 3,000 dietary supplements sold in the United States through retail establishments, mail-order catalogs, and the Internet. It also describes the Dietary Supplement Product Database, which contains information collected for each of these products and provides a summary of the information in the database.

AGENCY SPONSOR: Food and Drug Administration

FEDERAL CONTACT: Clark Nardinelli, 202-205-8702

PIC ID: 7082

PERFORMER: Research Triangle Institute, Research Triangle Park, NC

Evaluation of Written Prescription Information Provided in Community Pharmacies: An 8-State Study

This evaluation assessed the quality of written prescription information provided voluntarily to individuals receiving new prescription medicines in community pharmacies. The study tested whether fictitious patients as observers were given any written prescription information by pharmacists whom they asked for drugs prescribed (in addition to the labels and stickers on their medication containers). The quality of written information was also assessed. This pilot study produced encouraging results for consumers: (1) nearly 87% of new prescriptions were dispensed with some written prescription information in addition to the label and stickers on the medication container, suggesting that the provision of written prescription information is becoming a routine practice in community pharmacies; and (2) expert panelists found that most written information sheets were accurate and unbiased in content and tone. They included necessary details for monitoring and interpreting adverse reactions and appeared legible and comprehensible to consumers. The study raised several concerns: most patient information was rated low on identifying precautions, their significance, and how to avoid them, and storage instructions and general information. The study will be repeated nationally in 2001 and the results will be used to identify areas for improvement in consumer communication of prescription information.

AGENCY SPONSOR: Center for Drug Evaluation and Research

FEDERAL CONTACT: Mary Bender, 202-205-5592

PIC ID: 7496

PERFORMER: University of Wisconsin, Madison, WI

FY 2000 Performance Report to Congress for the Prescription Drug User Fee Act (PDUFA) of 1992

The Prescription Drug User Fee Act (PDUFA) authorized FDA to collect fees from companies that produce human drug and biological products. The PDUFA annual performance report to Congress for FY 2000 focuses on the Agency's performance toward the agreed-upon numeric goals for reviewing and acting on submissions and responding to sponsors' pre-submission requests. The major accomplishments to report are: (1) FDA continued to exceed nearly all the review performance goals in FY 2000— increasing numbers of applications filed; higher quality applications; quicker approvals for products with the requisite data; and outcomes that result in more quality products reaching American practitioners and consumers faster; (2) application filings and quality remain high by historic standards and approval times continue to drop; (3) compared to the approval rates for all new drug applications, there is a smaller increase in approval rates for new molecular entities (NMEs), unique new drugs that are approved for the first time by FDA; (4) median total approval time (i.e., time from the initial submission of a marketing application to the issuance of an approval letter) for priority applications submitted in FY 99 was 6 months, less than half the median approval times for priority applications submitted in the early PDUFA years. The FDA performance report states that since the passage of PDUFA there has been a shift in the pattern of NME introductions with more American patients now receiving the benefits of important new drugs before they are available to citizens of other countries. This shift requires that FDA be increasingly vigilant in its post- market surveillance efforts.

AGENCY SPONSOR: Food and Drug Administration

FEDERAL CONTACT: Dennis Hill, 301-827-5255

PIC ID: 6079.5

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

Infant Immunization with Acellular Pertussis Vaccines in the US: Assessment of the First Two Years' Data from the Vaccine Adverse Event Reporting System (VAERS)

The objective of this study was to evaluate the safety of infant immunization with acellular pertussis vaccines in the U.S. The study consisted of reports of infant immunization against pertussis between January 1, 1995 (when whole-cell vaccine was in exclusive use) and June 30, 1998 (when acellular vaccine was in predominant use). The annual number of reported events categorized as non-fatal serious reported to the Vaccine Adverse Event Reporting System (VAERS) for all pertussis-containing vaccines declined between 1995 and 1998. It was concluded that VAERS data (although subject to the limitations of passive surveillance) support the prelicensure data with regard to the safety of the US licensed acellular pertussis vaccines that were evaluated.

AGENCY SPONSOR: Center for Biologics Evaluation and Research

FEDERAL CONTACT: Miles M. Braun, 301-827-3974

PIC ID: 7251

PERFORMER: Food & Drug Administration, Ctr. for Biologics Evaluation, Rockville, MD

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

The Food and Drug Administration (FDA) uses the Food Label and Package Survey (FLAPS) data to support policy, regulatory, food safety decisions, and economic impact assessments. FDA has used FLAPS data to gain information on nutrition labeling on product packages, the extent of labeling on various nutrients, the extent of use of specific product ingredients; the accuracy of product serving sizes, and the prevalence of various health claims on food products. In 1997, FDA conducted the eleventh FLAPS survey. Findings indicated that nutrition-labeled products accounted for an estimated 97% of the annual sales of processed, packaged foods. 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: Lori A. LeGault, 202-205-5269

PIC ID: 5711.2

PERFORMER: A.C. Nielsen Company

Schaumburg IL

Survey of Manufacturing Practices in the Dietary Supplement Industry

The Food and Drug Administration contracted with the Research Triangle Institute (RTI) to conduct a survey of the dietary supplement industry to learn more about manufacturing practices in the industry and what constitutes good manufacturing practices (GMPs). This effort is part of the process of considering whether to institute rule making to develop GMP regulations. Information from this survey was to help the agency formulate a policy to ensure that dietary supplement products are produced under conditions that will result in a safe and properly labeled product without unnecessary costs to the industry. A sample of 966 dietary supplement establishments were selected from the Dietary Supplement Enhanced Establishment Database. A telephone/mail survey was used for data collection and a total of 238 completed questionnaires were received. This report describes the sample design and survey administration procedures and presents summary statistics for the survey questions.

AGENCY SPONSOR: Center for Food Safety and Applied Nutrition

FEDERAL CONTACT: Clark Nardinelli, 202-205-8702

PIC ID: 7499

PERFORMER: Research Triangle Institute, Research Triangle Park, NC

The FDA Regulatory Methods Validation Program for New and Abbreviated New Drug Applications

This report published in Pharmaceutical Technology in January 2000. The article describes the Food and Drug Administration methods validation program for proposed regulatory methods submitted through the new abbreviated new drug application processes. The program is conducted by the Center for Drug Evaluation and Research (CDER) to ensure that scientifically well-founded regulatory methods are available to assess the quality of CDER-approved products. Industry, FDA, and the United States Pharmacopeia and the National Formulary have the common objective of ensuring that drugs in the US marketplace have consistent standards for drug substances and drug product regardless of the synthesis and manufacturing process. This is achieved by ensuring that the analytical methods used for new drug products are submitted for adoption as public standards soon after approval for marketing.

AGENCY SPONSOR: Center for Drug Evaluation and Research

FEDERAL CONTACT: Moheb Nagr, 314-589-2136

PIC ID: 7106

PERFORMER: Food and Drug Administration, St. Louis, MO

In-Progress Evaluations

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.

EXPECTED DATE OF COMPLETION:10/01/2001

AGENCY SPONSOR: Center for Drug Evaluation and Research

FEDERAL CONTACT: Jerry Collins, 301-427-1065

PIC ID: 7103

PERFORMER: Food and Drug Administration, Rockville MD

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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Center for Food Safety and Applied Nutrition

FEDERAL CONTACT: Mary E Bender, 202-205-5592

PIC ID: 5711.3

PERFORMER: Food and Drug Administration, Rockville, MD

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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Center for Devices and Radiological Health

FEDERAL CONTACT: Orhan Suleiman, 301-594-3533

PIC ID: 4984

PERFORMER: Food and Drug Administration, Rockville MD

Prescription Drug User Fee Act Reports

The Prescription Drug User Fee Act (PDUFA) of 1992 provided FDA with greater resources for the review of human drug and biologic applications. Fees that FDA collected from drug and biologics firms were used to reduce the time required to evaluate human drug applications without compromising review quality. FDA has submitted annual Performance and Financial Reports to Congress on progress in streamlining the drug review process and use of PDUFA fees. The original act expired September 30, 1997, but the FDA Modernization Act of 1997 amended and extended PDUFA through September 30, 2000. The amended act is now referred to as PDUFA II and its predecessor as PDUFA I.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Food and Drug Administration

FEDERAL CONTACT: Dennis Hill, 301-827-5255

PIC ID: 6079.6

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

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.

EXPECTED DATE OF COMPLETION:10/01/2001

AGENCY SPONSOR: Center for Biologics Evaluation and Research

FEDERAL CONTACT: Miles M. Braun, 301-827-3974

PIC ID: 6736

PERFORMER: Food and Drug Administration, Rockville MD

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.

EXPECTED DATE OF COMPLETION:03/02/2001

AGENCY SPONSOR: Center for Food Safety and Applied Nutrition

FEDERAL CONTACT: Clark Nardinelli, 202-205-8702

PIC ID: 6866

PERFORMER: Food and Drug Administration, Rockville MD

Health Resources and Services Administration (HRSA)

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 (HRSA) supports a wide array of very different programs and activities that promote access to needed health care for all, including primary health care centers, the National Health Service Corps, HIV/AIDS programs, maternal and child health activities, health professions training, rural health programs, organ donation and transplantation initiatives, and telehealth activities. To provide underpinning for these efforts, HRSA’s evaluation program is designed to enhance strategic planning, strengthen budget and legislative development, and improve program performance.

HRSA’s evaluation priorities are in the following areas:

  • Performance Measurement and Information Systems–To improve information collection, reporting and use, this area includes assistance, training, and support to increase the agency’s capacity to respond to the requirements of the Government Performance and Results Act (GPRA) and to enhance the data systems that are needed for effective program planning, management and evaluation.
  • Program Implementation and Management–To identify opportunities for improvement in HRSA-supported programs and strategies, this area includes studies that provide information useful in developing, implementing, and modifying program approaches and operations.
  • Program Effectiveness–To determine the outcomes of HRSA-supported programs, studies in this area assess the intermediate and longer-term results or impact of programs in achieving specified goals and objectives.
  • Environmental Assessment–To assess the impact of crosscutting issues on HRSA and its constituencies, 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.

HRSA also supports activities to enhance the quality of evaluation agency-wide, such as funding short courses in evaluation for staff and expanding agency staff’s access to technical assistance on the conceptualization, design and implementation of evaluation activities. The broad dissemination of evaluation products and results is also an area of emphasis.

Fiscal Year 2000 Evaluation Reports

An Evaluation of Outcomes Among PLWH Receiving Services from RWCA- Funded Programs

The purpose of this set of studies is to evaluate client- and system-level outcomes achieved as a result of services provided by Ryan White CARE Act (RWCA) grantees and providers. Priorities for evaluating the impact of the RWCA are responsive to grantee requests for assistance with evaluation, the Government Performance and Results Act (GPRA), and amendment to the CARE Act of 1996. Questions to be addressed include whether HRSA's HIV/AIDS programs are: 1) enrolling underserved and vulnerable populations in primary health care; 2) providing clients with quality/continuity of primary care similar to care received by other people living with HIV; 3) providing services that remove barriers to primary care services for CARE Act clients; 4) reducing morbidity and perinatal transmission of HIV disease; 5) reducing HIV-related mortality; and 6) adapting to change in health care (e.g., availability of anti-retroviral therapies and the growth of managed care). The California State Office of AIDS is investigating whether RWCA programs reduce opportunistic infections, and whether there are increased or slowed rates of decline in CD4 counts and declines in perinatal transmission of HIV disease. The New York University Medical Center is examining outcomes over three time periods: pre-RWCA funding (1985-1991), RWCA implementation (1992-1996), and RWCA maturity (1997-2000). The University of Pittsburgh is analyzing Pittsburgh AIDS Center for Treatment outcomes data during 1997-1998. The Washington University School of Medicine is studying patients enrolled during 1997-1998 in the Men's HIV Program and the Helena Hatch Special Care Center for adolescent and adult women with HIV.

AGENCY SPONSOR: HIV/AIDS Bureau

FEDERAL CONTACT: Faye Malitz, 301-443-3259

PIC ID: 6177

PERFORMER: California State Office of AIDS, Sacramento, CA

Comorbidity-Based Payment Methodology for Medicaid Enrollees with HIV/AIDS

The purpose of this study was to compare specific methodologies for setting capitation rates for people with HIV or AIDS and to analyze the predictive power of those payment models using data from the Medicaid program in Maryland. Specifically, the models tested were the current Maryland approach based on Ambulatory Care Groups, a payment model based on uniform payments for HIV-positive non-AIDS individuals, and a third model based incorporating information on co-morbidities. The three models were then evaluated by simulating payments under the three approaches and comparing them to actual costs of care under a range of different assumptions about the distribution of types of patients. The researchers conclude that the co-morbidity-based payment approach would more equitably reimburse managed care organizations for the costs of care for higher cost patients than the other two alternatives.

AGENCY SPONSOR: HIV/AIDS Bureau

FEDERAL CONTACT: Richard Conviser, 301-443-3075

PIC ID: 7095

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

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

The purpose of this study was to compare demographic characteristics, services needed and provided, and health outcomes between persons receiving CARE Act-funded services and the general treatment population. This study also reports on the clinical characteristics of patients attending a single practice which receives substantial support through Ryan White and assessed if there are differences in clinical outcomes based on payor status. Specifically, the report looks at the Johns Hopkins University AIDS Service (JHUAS), a large, urban, hospital-based clinical practice that has received funding through the Ryan White CARE Act to deliver HIV primary care and subspecialty services since 1990. The study tested these two hypotheses: 1) There are no differences in access to clinical services based on payor status, in particular, receipt of guidelines-recommended highly active combination antiretroviral therapy (HAART). 2) There are no differences in clinical outcomes based on payor status. In 1990, a clinical database was established within the JHUAS designed to capture comprehensive longitudinal data on patients attending this clinical practice. Payor status is assessed through the institution's visit registration database, which captures the method of payment for each completed visit. The results show some resource utilization differences and some differences in receipt of antiretroviral therapies based on payor status. However, in multivariate analysis, there were no differences in development of AIDS and survival among payor types.

AGENCY SPONSOR: HIV/AIDS Bureau

FEDERAL CONTACT: Richard Conviser, 301-443-3075

PIC ID: 7123

PERFORMER: Johns Hopkins Medical Institutions, Baltimore, MD

Effect of Healthy Start on Infant Mortality and Birth Outcomes

This report presents findings on the effects of Healthy Start on prenatal care utilization, key birth outcomes, and infant mortality in the 15 original project areas selected as demonstration sites by the Health Resources and Services Administration (HRSA). The principal findings are: (1) In eight of the 15 project areas, Healthy Start is associated with improved adequacy of prenatal care utilization. (2) Healthy Start is associated with increases in the adequacy of prenatal care initiation in 4 of the 15 project areas. (3) Healthy Start is associated with improved adequacy of the number of prenatal care visits in 9 of the 15 project areas. (4) Three project areas--New Orleans, New York City, and Philadelphia--show improvements in all measures of prenatal care as a result of Healthy Start. The report also statistically illustrates how Healthy Start contributed to declines in several birth outcomes such as Preterm Rate-- shows significant declines in four project areas; Low Birthweight-- Three projects with statistically significant reductions in the percentage of infants with birthweight less than 2,500 grams; and Infant Mortality Rate-- two project areas, New Orleans and Pittsburgh, Healthy Start is related to a statistically significant decline in the number of infant deaths per thousand live births. The report concludes that Healthy Start is particularly successful at linking women and their families to prenatal care, as shown by improvements in the adequacy of prenatal care utilization in 8 of the 15 original project areas.

AGENCY SPONSOR: Office of the Administrator

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

PIC ID: 5610.3

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

Evaluation of the Health Resources and Services Administration's National Health Service Corps Program

The purpose of this project was 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. This study again looks at the question of retention and sought answers to other vital questions as well. For example, To what extent has the NHSC fulfilled its mission of building self-sufficient health care delivery systems in areas where health care professionals are in short supply? To what extent do NHSC mentor or advocacy relationships help students and providers to practice medicine in underserved areas? Have NHSC providers improved clinical practice standards in underserved areas? The results presented in this report are based on two samples of alumni and current NHSC clinicians. The findings from the study indicate underserved areas continue to need NHSC placements if they are to provide basic health care to a growing and diverse population. The NHSC program not only provides services but also contributes in many ways to extending and expanding access to basic health care services and improving the health care delivery system in underserved communities.

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Richard Niska, 301-594-4204

PIC ID: 6357

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

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

The purpose of this study was to conduct a comprehensive assessment of the level of participation of Historically Black Medical Colleges (HBMC) in HRSA-supported health professions training programs. The study involved an analysis of grant funding for the HBMCs as well as interviews with HRSA program staff and informants from the HBMCs. The final report is primarily narrative and presents 11 findings and 14 recommendations. Generally speaking, the report suggests that HRSA and HBMCs share complementary missions that serve as the basis for developing a stronger working relationship. The report recommends that the relationship be built around stable funding for those HBMCs that can demonstrate that they are producing measurable outcomes that are associated with clearly defined objectives. Those objectives should be related to production of health professionals who are committed to serving the medically under served.

AGENCY SPONSOR: Office of the Administrator

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

PIC ID: 7121

PERFORMER: Health Resources and Services Administration, Rockville MD

Lesbian, Gay, Bisexual, and Transgender Health: Findings and Concerns

This project developed a discussion paper that addresses health and health care issues for Gay, Lesbian, Bisexual, and Transgender (GLBT) populations. The report discusses the lack of systematic information on the health of GLBT populations, and addresses what are called threshold issues for these groups, including the public health infrastructure, access to quality health services, health communication, and educational and community-based programs. Also reviewed are disease/condition-specific concerns of GLBT populations and other issues such as barriers to care. The report concludes with a review of the methodological challenges to studying Lesbian, gay, bisexual and transgender health.

AGENCY SPONSOR: Office of the Administrator

FEDERAL CONTACT: Melissa Clarke, 301-443-5277

PIC ID: 6813

PERFORMER: Gay and Lesbian Medical Association, San Francisco, CA

New Rules, New Roles: How Title V/MCH and Ryan White Programs and Providers are Adapting to Medicaid Managed Care

This study examined how Medicaid managed care is affecting state agencies and local medical and social service providers funded under the Title V/MCH Services Block Grant program or the Ryan White CARE Act. Managed care has raised different issues for the two programs: for example, only the Title V/MCH program has had to address issues related to its public health role. Several themes repeatedly recurred during visits to Title V/MCH and Ryan White organizations, namely: Many Title V/MCH and Ryan White medical providers have been able to contract with managed care plans for at least some services; Whether providers receive any Medicaid reimbursement for case management depends largely on Medicaid program requirements; Providers contend that reimbursement rates are too low, regardless of whether they are reimbursed by managed care plans, the state Medicaid agency, or the Title V/MCH or Ryan White programs; Many social service providers lack the managed care expertise and staff resources to market their services to managed care plans; Providers that have managed care contracts are struggling with increased administrative demands; Program and provider staff believe that, in general, access to care and quality of care remain adequate, but fear that both may suffer if financial pressure continues to mount.

AGENCY SPONSOR: Health Resources and Services Administration

FEDERAL CONTACT: Alexander Ross, 301-443-1512

PIC ID: 6816

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

Reducing Infant Mortality: Lessons Learned from Healthy Start

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: Karen Thiel Raykovich, 301-443-0370

PIC ID: 5610

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

Region VIII Dental Infrastructure Project Assessment of Colorado, North Dakota and South Dakota

This project performed an assessment of three states' dental public health infrastructures using a variety of data sets collected from national, state and local sources, including Medicaid data, and data from the Area Resource File. The intent was to establish a baseline of information for future analyses of changes and trends. The project also tested the utility of GIS mapping as a tool for assembling and displaying information necessary for dental infrastructure assessment. The final report describes dental demand, supply and distribution in the study states. The project confirmed that acquiring local and national data, displaying the results on state and regional maps, and training state and regional dental health professions in the use of GIS is of value to the recipients and promotes ongoing integration of these tools into routine operations. A CD-ROM was produced to provide access to the database.

AGENCY SPONSOR: Office of the Administrator

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

PIC ID: 7242

PERFORMER: Quality Resource Systems, Inc., Fairfax, VA

Studies and Papers

The "Studies and Papers" series contains original papers contributed by Health Resources and Services Administration staff, as well as abstracts of papers previously published or presented at meetings. The publications cover a broad spectrum of programmatic and administrative activities including (1) health care delivery to underserved persons; (2) health services for Native Americans; (3) AIDS campaign; (4) organ transplants; (5) health professions training; (6) tracking of health professionals and monitoring of their competence by operating a nationwide data bank on malpractice claims and sanctions; and (7) monitoring of developments affecting health facilities, especially those in rural areas. The PIC collection of this series begins with the Summer 1987 issue.

AGENCY SPONSOR: Health Resources and Services Administration

FEDERAL CONTACT: Frank Sisk, 301-443-2086

PIC ID: 3094

PERFORMER: Office of Planning, Evaluation and Legislation, Rockville MD

In-Progress Evaluations

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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Office of the Administrator

FEDERAL CONTACT: Lynette Araki, 301-443-6204

PIC ID: 7250

PERFORMER: Westat, Inc., Rockville MD

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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Kathleen Shannon, 301-594-3621

PIC ID: 7284

PERFORMER: North American Management Company, Alexandria, VA

Assessment of HRSA's Distance Learning Program

This project is the initial phase of a longer-term effort to evaluate the effectiveness of HRSA's many efforts to disseminate information and provide education and training through various distance learning techniques. To inform this eventual assessment, this project will: (1) provide a review of relevant literature on the relative effectiveness of different distance learning approaches; (2) catalogue HRSA's dissemination and distance learning programmatic efforts to determine the methods and purposes for which they are used; (3) examine the data currently being collected on these efforts and the utility of those data; (4) determine additional data and analytical needs; and (5) recommend designs for an evaluative study.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Maternal and Child Health Bureau

FEDERAL CONTACT: Jacob Tenenbaum, 301-443-9011

PIC ID: 7114

PERFORMER: The Lewin Group, Falls Church, VA

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.

EXPECTED DATE OF COMPLETION:12/31/2001

AGENCY SPONSOR: Maternal and Child Health Bureau

FEDERAL CONTACT: Jacob Tenenbaum, 301-443-9011

PIC ID: 7236

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

Cost-Benefit of HIPPA

This is a multi-phase study that focuses on groups that have been in the forefront of interacting with the population affected by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and three HIPAA related provisions: MHPA (Mental Health Parity Act of 1996), NMPHA (Newborns and Mothers' Health Protection Act of 1996) and WHCRA (Women's Health and Cancer Rights Act of 1998). The groups, i.e., State agencies, consumer advocacy groups or individual researchers, are being contacted and benefits, in terms of assisting individuals in obtaining coverage as guaranteed under HIPAA and related provisions, identified. Since strategy for implementation of HIPAA is technically based on State insurance regulatory models, the project will delineate and describe similar and/or differing effects as this model is applied at the Federal level. Evaluation results will lead to assisting CMS in the planning of any future endeavors in private health insurance regulation.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Office of the Administrator

FEDERAL CONTACT: James Fuller, 410-786-3365

PIC ID: 7420

PERFORMER: Arthur Andersen and Company, Washington, DC

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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Rhonda Hughes, 301-594-4280

PIC ID: 6784

PERFORMER: Zuvekas, Ann, Consultant, Annandale, VA

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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Office of the Administrator

FEDERAL CONTACT: Michael Millman, 301-443-0368

PIC ID: 7241

PERFORMER: Chicago Center for Health Systems Development, Chicago, IL

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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Bureau of Health Professions

FEDERAL CONTACT: Madeleine Turkletaub, 301-443-6193

PIC ID: 7130

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

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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Fred Butler, 301-549-4281

PIC ID: 7126

PERFORMER: MDS Associates, Inc., Wheaton, MD

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

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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Barbara Wells, 301-594-4463

PIC ID: 6364

PERFORMER: MDS Associates, Inc., Wheaton, MD

Health Status Outcome Measures for the Bureau of Primary Health Care: Examination of Episodes of Care for Diabetes, Hypertension, Asthma

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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Barbara Wells, 301-594-4463

PIC ID: 7127

PERFORMER: MDS Associates, Inc., Wheaton, MD

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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Barbara Wells, 301-594-4463

PIC ID: 6802

PERFORMER: The Lewin Group, Fairfax, VA

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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: HIV/AIDS Bureau

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

PIC ID: 7267

PERFORMER: Johns Hopkins University School of Medicine, Baltimore, MD

Hospital Organ Donation Best Practices: Study Design

The purpose of this project is to develop an approach to investigate factors associated with variations in hospital organ and tissue donation rates. Such factors include but are not limited to family request practices and hospital referral patterns for reporting deaths and imminent deaths to Organ Procurement Organizations (OPO). The goal is to be able to identify hospital and OPO practices that are associated with higher donor referral, consent, and recovery. Contingent upon the success of this design phase, a study will be implemented and information on best practices will be shared with the hospital and transplant communities to stimulate improvement in donation practices.

EXPECTED DATE OF COMPLETION:11/30/2001

AGENCY SPONSOR: Office of Special Programs

FEDERAL CONTACT: Mary Ganikos, 301-443-7577

PIC ID: 7288

PERFORMER: The Lewin Group, Falls Church, VA

Impact of Increased Dental Medicaid Reimbursement Rates

The purpose of this study is to evaluate the impact of increased Medicaid dental fees on children's utilization of dental services and access to dental care in South Carolina. The study will also include an analysis of the supply of dentists that accept Medicaid and the geographic distribution before and after the fee increase. In addition, it will assess changes in the utilization patterns of preventive and restorative care, and will examine the feasibility of developing performance measures that could be tracked using Medicaid data. The study will involve analysis of Medicaid and other extant databases, and secondary analysis of a survey by the South Carolina Dental Association.

EXPECTED DATE OF COMPLETION:01/31/2002

AGENCY SPONSOR: HIV/AIDS Bureau

FEDERAL CONTACT: Raul A. Romaguera, 404-562-4180

PIC ID: 7196

PERFORMER: Medical University of South Carolina, Charleston, SC

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.

EXPECTED DATE OF COMPLETION:09/30/2002

AGENCY SPONSOR: Bureau of Primary Health Care

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

PIC ID: 6039

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

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.

EXPECTED DATE OF COMPLETION:09/30/2002

AGENCY SPONSOR: HIV/AIDS Bureau

FEDERAL CONTACT: Faye Malitz, 301-443-3259

PIC ID: 7215

PERFORMER: The Learning Group Corporation, Rockville MD

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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Office of the Administrator

FEDERAL CONTACT: Alexander Ross, 301-443-1512

PIC ID: 6815

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

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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Evelyn Moses, 301-443-6315

PIC ID: 6864

PERFORMER: Harvard University, Holyoke Center, Cambridge MA

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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Office of the Administrator

FEDERAL CONTACT: Alexander Ross, 301-443-1512

PIC ID: 7240

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

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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Jean Yoon, 301-594-6460

PIC ID: 7125

PERFORMER: George Washington University, Washington, DC

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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Jerrilynn Regan, 301-594-4283

PIC ID: 6811

PERFORMER: Research Triangle Institute, Research Triangle Park, NC

Indian Health Service (IHS)

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.

In-Progress Evaluations

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.

EXPECTED DATE OF COMPLETION: 12/30/2002

AGENCY SPONSOR: Office of Public Health

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

PIC ID: 7128

PERFORMER: Indian Health Service, Rockville MD

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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Office of Public Health

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

PIC ID: 5940

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

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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Office of Public Health

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

PIC ID: 6741

PERFORMER: Indian Health Service

Rockville MD

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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Office of Public Health

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

PIC ID: 5018

PERFORMER: IHS Billings Area Office

Billings MT

Dental Caries in Preschool Children

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

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Office of Public Health

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

PIC ID: 5531

PERFORMER: Indian Health Service

Rockville MD

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.

EXPECTED DATE OF COMPLETION:09/01/2001

AGENCY SPONSOR: Office of Public Health

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

PIC ID: 6408

PERFORMER: Nashville Area Indian Health Service

Nashville TN

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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Office of Public Health

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

PIC ID: 5938

PERFORMER: Nashville Area Indian Health Service

Nashville TN

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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Office of Public Health

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

PIC ID: 6746

PERFORMER: Indian Health Service

Rockville MD

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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Office of Public Health

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

PIC ID: 7138

PERFORMER: Indian Health Service

Rockville MD

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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Indian Health Service

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

PIC ID: 7137

PERFORMER: Indian Health Service

Rockville MD

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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Office of Public Health

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

PIC ID: 7139

PERFORMER: Indian Health Service

Rockville MD

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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Office of Public Health

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

PIC ID: 7140

PERFORMER: Indian Health Service

Rockville MD

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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Office of Public Health

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

PIC ID: 7141

PERFORMER: Indian Health Service

Rockville MD

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 in the hospital and at well-child clinics. Methods to increase awareness of the benefits of using car seasts will include "buckle-up" campaigns and encouraging tribal councils to pass and enforce seat belt ordinances.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Office of Public Health

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

PIC ID: 5529

PERFORMER: Indian Health Service

Rockville MD

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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Office of Public Health

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

PIC ID: 5943

PERFORMER: California Area Indian Health Service

Sacramento, CA

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.

EXPECTED DATE OF COMPLETION:12/30/2001

AGENCY SPONSOR: Office of Public Health

FEDERAL CONTACT: Elizabeth A. Fowler

301-443-3024

PIC ID: 7029

PERFORMER: Indian Health Service

Rockville MD

Pueblo 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.

EXPECTED DATE OF COMPLETION:09/01/2001

AGENCY SPONSOR: Office of Public Health

FEDERAL CONTACT: Elizabeth A. Fowler

301-443-3024

PIC ID: 6411

PERFORMER: Indian Health Service

Rockville MD

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.

EXPECTED DATE OF COMPLETION:09/29/2001

AGENCY SPONSOR: Office of Public Health

FEDERAL CONTACT: Elizabeth A. Fowler

301-443-3024

PIC ID: 6450

PERFORMER: Information and Management Technologies, Inc.

Silver Spring, MD

Study of the Impact of a Full-Time Community Health Nurse on the Health of Native American (Sioux) Patients with Hypertension & Prevention of and Education Cerebrovascular, Cardiovascular and Renal Disease

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.

EXPECTED DATE OF COMPLETION:09/01/2001

AGENCY SPONSOR: Office of Public Health

FEDERAL CONTACT: Elizabeth A. Fowler

301-443-3024

PIC ID: 6413

PERFORMER: Aberdeen Area Indian Health Service

Aberdeen, SD

 

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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Office of Public Health

FEDERAL CONTACT: Elizabeth A. Fowler

301-443-3024

PIC ID: 6742

PERFORMER: Billings Area Indian Health Service

Billings, MT

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) readminister 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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Office of Public Health

FEDERAL CONTACT: Elizabeth A. Fowler

301-443-3024

PIC ID: 4996

PERFORMER: Southeast Alaska Regional Health Corporation

Sitka, AK

National Institutes of Health (NIH)

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, which considers TMRC recommendations, conducts policy level reviews, and makes final funding recommendations to the NIH Director or his designee.

Fiscal Year 2000 Evaluation Reports

Addressing the Nation's Changing Needs for Biomedical and Behavioral Scientists

This report, the eleventh in a series that began in 1975, reviews the recent production and current supply of scientists. Unlike earlier studies, it also considers research training mechanisms other than National Research Service Awards (NRSA) training grants and fellowships. A demographic analysis was conducted by the Committee on National Needs for Biomedical and Behavioral Scientists and it conducted a review of such indicators of short-term demand as trends in faculty and industry hiring and perceptions of the job market by recent Ph.D.s. It found that the number of new Ph.D.s awarded annually in the basic biomedical sciences is well above that needed to keep pace with growth in the U.S. economy and that the number of new PH.D.s awarded annually in the behavioral and social sciences is also sufficient and recommended that overall Ph.D. production in these fields should not be increased; they found a decline in the number of M.D.s conducting research while Ph.D.s awarded in clinical science fields have increased at a rate faster than in the biomedical or behavioral sciences. The recommendation to NRSA is to intensify efforts to train and retain physicians until the trend is reversed. There was also a finding for increasing the supply of minority scientists in biomedical and behavioral research and more minority and nonminority investigators turning their attention to disparities in health. The committee recommends improving opportunities for minority studies in secondary schools, an education level outside the scope of the existing NRSA program.

AGENCY SPONSOR: Office of the Director

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

PIC ID: 4664.1

PERFORMER: National Academy of Sciences, Washington, DC

Baltimore City Health Department: Ten Year Evaluation of Coverage and Effect on Student Childbearing and School Dropout

The Baltimore City Health Department (BCHD) established a Comprehensive School Health Services Program (CSHSP) in collaboration with the Baltimore City Public Schools. The goal was to create a single comprehensive health model for adolescents attending selected secondary schools. This evaluation describes CSHSP success in engaging students and in preventing student child bearing and dropouts. For students who did bear a child, the study describes CSHSP success in promoting adequate prenatal care and favorable birth outcomes. The research applies time series and cohort analyses to measure program coverage and impact in the CSHSP's first ten years, from 1985-86 through 1994-95. Study data were derived by matching existing computer files of school registration data, CSHSP registration and utilization data and birth certificates. The CSHSP was successful in engaging a majority of students in both middle and high schools. During the ten year study period, school birthrates rose then fell back to levels similar to those when the CSHSP was first initiated. The CSHSP was closely linked to prevention of school dropout. Within CSHSP schools, age-for-grade appropriate ninth graders who used the CSHSP were significantly more likely to stay in school. The study demonstrated the feasibility of evaluating the CSHSP through matching and secondary analysis of existing data sources. The CSHSP did not influence school-wide birthrates, but for students who did use the school-based clinics, birthrates during the high school years decreased by 5% and school dropout rates decreased by over a third.

AGENCY SPONSOR: National Institute of Child Health and Human Development

FEDERAL CONTACT: Susan Newcomer, 301-435-6981

PIC ID: 4467

PERFORMER: Johns Hopkins University School of Medicine, Baltimore, MD

Evaluation of the Research Centers in Minority Institutions: Final Report 2000

The primary goal of the Research Centers in Minority Institutions (RCMI) Program has been to enable predominantly minority institutions to become more competitive in obtaining support for the conduct of biomedical and/or behavioral research relevant to the mission of the U.S. Public Health Service (PHS). To date, the National Center for Research Resources (NCRR) has funded 21 academic institutions. In 1995 NCRR began a two-phase evaluation of the RCMI Program to assess the extent to which the goals and objectives of the Program have been achieved during its first 10 years. The present Phase II study, which was conducted during 1998-1999, incorporated the evaluation design developed in Phase I and focused on the 15 institutions that had received RCMI funding for at least 10 years. As a group, the 15 institutions showed greater improvement in competing for research grants after 10 years of RCMI support than a comparable group of non-RCMI institutions, increasing their average grant funding by 139 percent compared with 56 percent for the comparison institutions. Also, for the group as a whole, correlation analysis indicated that scientific leadership, administrative leadership, and good management and communications systems were the factors most highly related to overall success. Recommendations were provided by the expert advisory panel, which consisted of six distinguished scientists. They recommended NCRR consider converting the RCMI grants to cooperative agreements, thus ensuring that the centers receive the technical assistance they need in order to achieve success.

AGENCY SPONSOR: National Center for Research Resources

FEDERAL CONTACT: Patricia A. Vorndran, 301-435-0866

PIC ID: 5580.1

PERFORMER: National Institutes of Health, Bethesda, MD

Midcourse Assessment of the Research Infrastructure in Minority Institutions Program

The National Center for Research Resources (NCRR) contracted with the Center for Health Policy Studies (CHPS) Consulting to conduct a midcourse assessment of the Research infrastructure in Minority Institutions (RIMI) grant program. In 1996, seven institutions were awarded RIMI funding to build their research capacity over a five year period. This report documents the assessment of the RIMI Program, which was performed at the end of the third year of funding. It was found that all seven of the RIMI institutions increased their capacity to conduct biomedical and behavioral research, as evidenced by numbers of research faculty, facility improvements and research activities. To varying extents, all schools have active collaboration with research intensive institutions; and schools are better prepared to compete for future research funding than they were three years ago. However, there is not enough evidence to definitively indicate whether schools are developing a critical mass of faculty investigators and research activity that will be self-sustaining beyond RIMI grant funding. They are on the track of doing so, but it is not clear that five years of RIMI funding will be enough for schools to stand on their own without it. Recommendations include decrease teaching loads for faculty members so they can be allowed time to conduct research; facilitate faculty interaction with other scientists; resolve procurement difficulties; and provide adequate staffing in laboratories.

AGENCY SPONSOR: National Center for Research Resources

FEDERAL CONTACT: Patricia A. Vorndran, 301-435-0866

PIC ID: 5580

PERFORMER: Center for Health Policy Studies, Columbia, MD

Oral Health in America: A report of the Surgeon General

The major message of this Surgeon General's report is that oral health is essential to the general health and well-being of all Americans and can be achieved by all Americans. Yet, not all Americans are achieving the same degree of oral health. While the Surgeon General's report is a comprehensive review of oral health as a public health issue, it is also in part a systematic scientific review of oral health research literature and an assessment of future research questions and priorities. Based on the oral health research review, the need for behavioral and clinical research, clinical trials, health services research, and community-based demonstration research is focused in several key areas. Development of risk assessment procedures for individuals and communities and of diagnostic markers to indicate whether an individual is more or less susceptible to a given oral disease can provide the basis for formulating risk profiles and tailoring treatment and program options accordingly. Progress is needed for a better understanding of the etiology and distribution of oral disease. The report states that epidemiologic and surveillance databases for oral health and disease, health services, utilization of care, and expenditures are limited or lacking at the national, state, and local levels. Such data are essential in conducting health services research, generating research hypotheses, planning and evaluating programs, and identifying emerging public health problems. Future data collection must address differences among the sub- populations making up racial and ethnic groups. More attention should be paid to demographic variables such as age, sex, sexual orientation, and socioeconomic factors in determining health status.

AGENCY SPONSOR: National Institute of Dental and Craniofacial Research

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

PIC ID: 6861

PERFORMER: National Institutes of Health, Bethesda, MD

In-Progress Evaluations

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 (NCI). 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.

EXPECTED DATE OF COMPLETION:12/28/2001

AGENCY SPONSOR: National Cancer Institute

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

PIC ID: 7116

PERFORMER: Rand Corporation, Santa Monica, CA

Evaluation of Internet-based Tools to Improve Cancer Clinical Trials

This project is an outgrowth of a comprehensive review of NCI's clinical trials program for cancer treatment. Based on this review, NCI has decided to restructure the way in which the Cooperative Groups, the largest single trials program sponsored by NCI, carry out large, randomized clinical trials. The restructuring will occur in a set-wise manner by focusing on a series of demonstration projects, all of which depend heavily on the use of automated applications distributed via the Internet. The evaluation project will carefully compare the new Internet-based methods with the previous methods using descriptive and inferential analyses.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: National Cancer Institute

FEDERAL CONTACT: Jeffrey Abrams, 301-496-2522

PIC ID: 7482

PERFORMER: Research Triangle Institute, Research Triangle Park, NC

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.

EXPECTED DATE OF COMPLETION:12/03/2001

AGENCY SPONSOR: Office of the Director

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

PIC ID: 6285

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

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.

EXPECTED DATE OF COMPLETION:10/30/2001

AGENCY SPONSOR: Office of the Director

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

PIC ID: 6862

PERFORMER: National Academy of Public Administration, Washington, DC

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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: National Center for Research Resources

FEDERAL CONTACT: Barbara Perrone, 301-435-0871

PIC ID: 6045.1

PERFORMER: James Bell Associates, Inc., Arlington, VA

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.

EXPECTED DATE OF COMPLETION:04/30/2002

AGENCY SPONSOR: National Institute of Child Health and Human Development

FEDERAL CONTACT: Rose Maria Li, 301-496-1175

PIC ID: 7115

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

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.

EXPECTED DATE OF COMPLETION:09/03/2001

AGENCY SPONSOR: National Center for Research Resources

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

PIC ID: 6863

PERFORMER: National Science Foundation, Arlington, VA

Office of the Assistant Secretary for Planning and Evaluation (ASPE)

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; assess the effects of managed care expansion on public health infrastructure; examine welfare-to-work approaches; test alternative methods of long-term care service delivery; and evaluate 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.

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 2000 Evaluation Reports

Office of Disability, Aging, and Long-Term Care Policy

  • A Survey of Employers Offering Group Long-Term Care Insurance to Their Employees
  • Evaluation of the District of Columbia's Demonstration Program - "Managed Care System for Disabled and Special Needs Children"
  • In-Home Supportive Services for the Elderly and Disabled: A Comparison of Client-Directed and Professional Models of Service Delivery
  • National Study of Assisted Living for the Frail Elderly
  • Post-Acute Care Issues for Medicare: Interviews with Provider and Consumer Groups, and Researchers and Policy Analysts
  • State Welfare-to-Work Policies for People with Disabilities: Implementation Challenges and Considerations
  • Synthesis and Analysis of Medicare Hospice Benefits
  • Synthesis and Analysis of Medicare Post-Acute Care Benefits and Alternatives
  • The Use of Nursing Home and Assisted Living Facilities Among Privately Insured and Non-Privately Insured Disabled Elders
  • Understanding Medicaid Home and Community Services: A Primer

Office of Health Policy

  • Access and Utilization of New Antidepressant and Antipsychotic Medications
  • An Inventory of Federal HIV-Related Databases
  • Consumer Protection in Private Health Insurance: The Role of Consumer Complaints
  • Consumer Protection in Private Insurance: State Implementation and Enforcement Experience
  • Employer Decision Making Regarding Health Insurance
  • Report to the President: Prescription Drug Coverage, Spending, Utilization, and Prices

Office of Human Services Policy

  • Assessment of Major Data Sets for Analysis of Hispanic and Asian or Pacific Islander Subgroups and Native Americans
  • Coordination and Integration of Welfare and Workforce Development Systems
  • Dynamics of Children's Movement Among the AFDC, Medicaid, and Foster Care Programs Prior to Welfare Reform: 1995-1996
  • Evaluating Alternative Welfare-to-Work Approaches: Two-Year Impacts for Eleven Programs
  • Evaluation of the New York City Homerebuilders Demonstration
  • Health Conditions Utilization and Expenditures of Children in Foster Care
  • Impacts on Young Children and Their Families Two Years After Enrollment: Findings from the Child Outcomes Study
  • Impacts on Young Children and Their Families Two Years After Enrollment: Findings from the Child Outcomes Study - Summary Report
  • Implementation, Participation Patterns, costs, and Two-Year Impacts of the
  • Detroit Welfare-to-Work Program
  • Indicators of Welfare Dependence: Annual Report to Congress
  • Oklahoma City's ET&E Program: Two-Year Implementation, Participation, Cost, and Impact Findings
  • Study of Welfare-to-Work Programs Serving Non-Custodial Parents
  • The Low-Wage Labor Market: Challenges and Opportunities for Economic Self-Sufficiency
  • The Role of Intermediaries in Linking TANF Recipients with Jobs: Final Report
  • Trends in the Well-Being of America's Children & Youth: 1999
  • Welfare Leavers and Medicaid Dynamics: Five States in 1995
  • What Works Best for Whom: Impacts of 20 Welfare-to-Work Programs by Subgroup

Office of Program Systems

  • Community-Level Indicators for Understanding Health and Human Services Issues
  • Food Safety Strategic Elements: Evaluation Synthesis Findings and Research Needs: Final Report

Office of Disability, Aging, and Long-Term Care Policy

A Survey of Employers Offering Group Long-Term Care Insurance to Their Employees

This final report provides information about current and best practices in the employer group LTC insurance market that can inform federal policy makers and employers in deciding how to construct a group LTC insurance offering. Current practices were collected from a random and select sample of employers and best practices were compiled from the select sample. The random sample survey generated a response rate of 58 percent. The total sample included 93 employers. The principle findings indicate the employer market provides greater access to coverage than in the individual market. A majority of employers offered less restrictive underwriting or even guarantee issue policies (i.e., did not require health information) during initial offerings to active, full-time employees. A majority offered coverage to at least one group in addition to full-time active employees (i.e., parents/inlaws, spouses, and retired employees), potentially extending the benefit well beyond the size of the employee population. Most employers usually limited the number of benefit choices. The majority offered two to four benefit amount options and a set package rather than allowing the employee to select every option separately. Nearly all employers used a single LTC insurer. Despite this, however, data from a random sample of employers suggest that the benefit features of employer group plans generally resemble the most common individually purchased policies.

FEDERAL CONTACT: John Cutler, 202-690-6443

PIC ID: 6718.1

PERFORMER: The Lewin Group, Falls Church, VA

Evaluation of the District of Columbia's Demonstration Program - "Managed Care System for Disabled and Special Needs Children"

This evaluation focuses on an assessment of the District of Columbia's 1115 waiver demonstration to integrate acute and long-term care services for SSI (Supplemental Security Income) eligible children with disabilities in a single capitated payment system, called Health Services for Children with Special Needs (HSCSN). The evaluation shows that the capitated model tested in the demonstration is not viable. The main contributing factor is the insufficient size of the population of special needs children in the District to protect a plan against severe financial losses. Despite a proposal by the District's Medicaid Program to add stop-loss protection, HSCSN officials decided to not enter the waiver for re-competition. The impact of the demonstration on participants was mostly positive: better access to services and more satisfaction with services. Caregivers reported heavier use of medical services, particularly preventive services. They also felt less positive about the current or future health of the children being served. The policy implications of the evaluation indicated that coordinated and integrated care models still offer a valuable service despite the lack of success of the demonstration. In addition, policy makers need to consider alternative models of financing care management, such as primary care case management models that involve the child's primary physician in the coordination and integration.

FEDERAL CONTACT: Gavin Kennedy, 202-690-6443

PIC ID: 7361.1

PERFORMER: Abt Associates Inc., Cambridge, MA

In-Home Supportive Services for the Elderly and Disabled: A Comparison of Client-Directed and Professional Models of Service Delivery

The Office of the Assistant Secretary for Planning and Evaluation conducted a survey of personal assistance services clients, workers, and case managers to compare measures of quality of care, quality of life, client satisfaction, and worker satisfaction between a consumer-directed model (CDM) and a professionally directed model (PDM) of in-home supportive services delivery. The study also compared the outcomes associated with the use of family, friends, and neighbors as independent providers, as compared to services provided by aides previously unknown to the client. The study was conducted in the context of California's In-Home Supportive Services Program with the assistance of state officials. Findings regarding both models were generally positive; however, the study's principal finding is that clients in the CDM had more desirable outcomes than those in the PDM within three broadly defined areas: satisfaction with services, empowerment, and quality of life. Clients who hired family members as paid workers had more desirable outcomes on some measures in the areas of safety, satisfaction with services, and empowerment. Specifically, such clients reported a greater sense of security, having more choice about how their aides performed various tasks, a stronger preference for directing their aides, and a closer rapport with them.

FEDERAL CONTACT: Pamela Doty, 202-690-6443

PIC ID: 6173

PERFORMER: University of California at Los Angeles, Los Angeles CA

National Study of Assisted Living for the Frail Elderly

Research Triangle Institute (RTI) conducted the Discharged Residents Survey for the Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services through a subcontract with Myers Research Institute (MRI). The survey was administered during June and July 1999. This report documents the data collection activities undertaken by RTI for the survey. It describes procedures used to identify and local discharged residents, train staff, conduct and monitor data collection, and prepare the data file. It also includes a report on response rates and non-response weight adjustment calculations. See web site http:aspe.hhs.gov/daltcp/reports.htm.

FEDERAL CONTACT: Pamela Doty, 202-690-6443

PIC ID: 4719.7

PERFORMER: Research Triangle Institute, Research Triangle Park, NC

Post-Acute Care Issues for Medicare: Interviews with Provider and Consumer Groups, and Researchers and Policy Analysts

The 1997 Balanced Budget Act (BBA) was aimed at curbing the remarkably rapid rate of spending for post-acute care. This research was undertaken to provide an "early indication" qualitative study of the potential effects of the BBA provisions and other related issues. This study collected information through interviews with individuals knowledgeable about Medicare post-acute care issues. They included representatives of post-acute care providers (including discharge planners) and their organizations, quality of care experts, consumer groups, researchers, and health policy analysts. While this study was in progress, Congress enacted the 1999 Balanced Budget refinement Act (BBRA) which increased Medicare payments for post-acute care providers. These Acts have created some changes, however many important post-acute care policy issues remain unresolved, such as the goal of the Medicare home health benefit. Ambivalence about whether individuals requiring extended personal assistance with skilled supervision (who also tend to have high per-person costs) should be covered has resulted in the use of reimbursement policy strategies, such as the per-beneficiary limit in the HHA IPS to contain Medicare costs of those recipients. Also, providers, consumer representatives, and researchers expressed concern about access problems faced by individuals with particularly high service needs, such as Skilled Nursing Facilities (SNF) patients with high non-therapy ancillary costs, rehabilitation patients who exceed the Part B therapy caps, and home health patients whose costs exceed the per beneficiary limits.

FEDERAL CONTACT: Jennie Harvell, 202-690-6443

PIC ID: 7365.2

PERFORMER: Urban Institute, Washington, DC

State Welfare-to-Work Policies for People with Disabilities: Implementation Challenges and Considerations

This report focuses on State policy responses to two key aspects of the recent Federal welfare reform law that hold important ramifications for recipients with disabilities and caregivers--work participation and time limit requirements--and State flexibility to exempt recipients from one or both of these requirements. Findings are based on two primary data sources--written policy documents and conversations with State welfare agency staff in each of the 50 States and the District of Columbia--and reflect State policies at a single point in time (April-May 1998). Although this point in time review provides essential baseline information, it is important to note that States are likely to revisit these policies and may use the increased flexibility provided under Federal welfare reform to change policies over time. [Executive Summary and Full Report available at: http://aspe.hhs.gov/daltcp/reports.htm] The full report is in the Portable Document Format (PDF). You will need a copy of the Acrobat Reader in order to view it.]

FEDERAL CONTACT: William Marton, 202-690-6443

PIC ID: 4917.3

PERFORMER: The Lewin Group, Falls Church, VA

Synthesis and Analysis of Medicare Hospice Benefits

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 hospice services. However, a larger study is needed to examine key hospice trends nationally and in selected States. This report synthesizes the literature related to the Medicare hospice benefit and summarizes discussions with key informants about nursing home residents who elect this benefit. In addition, this report analyzes Medicare utilization and expenditures for beneficiaries electing the hospice benefit, analyzes and compares outcomes derived from the nursing home MDS data for decedents electing the hospice benefit with decedents not electing this benefit, and analyzes hospice coverage policy and utilization data from private insurers. This and other Medicare hospice benefit reports can be found at: http://aspe.hhs.gov/daltcp/projects.htm.

FEDERAL CONTACT: Jennie Harvell, 202-690-6443

PIC ID: 7154

PERFORMER: Urban Institute, Washington, DC

Synthesis and Analysis of Medicare Post-Acute Care Benefits and Alternatives

This project synthesized what is known about : (a) current coverage and payment policies for post-acute care (PAC); (b) predictors of PAC use and nonuse and of the type, amount, and duration of PAC use; (c) PAC utilization including characteristics of PAC patients, patterns of PAC utilization, and geographic distribution of providers; (d) Medicare expenditures during the course of PAC episodes; (e) outcomes of patients in and across PAC settings; and (f) State policies designed to maximize Medicare PAC coverage. Two reports have been reproduced. The first report, Medicare's Post-Acute Care Benefits: Background, Trends, and Issues to be Faced" provides background on post-acute care expenditures and utilization, and Medicare policy changes that have contributed to these trends; the supply and changes in distribution of post-acute care providers; beneficiary, provider, and market characteristics associated with differential post-acute care provider use; and issues that need to be addressed regarding Medicare post-acute care services. [see PIC ID#7365.1] The second report, "Interviews with Provider and Consumer Groups, and Researchers and Policy Analysts" summarizes discussions with key stakeholders regarding issues with Medicare's skilled nursing facility, home health, rehabilitation and long-term care hospital benefits. Many comments were raised regarding the impact of the changes enacted in the Balanced Budget Act on these benefits. [see PIC ID# 7365.2]

FEDERAL CONTACT: Jennie Harvell, 202-690-6443

PIC ID: 7365

PERFORMER: Urban Institute, Washington, DC

The Use of Nursing Home and Assisted Living Facilities Among Privately Insured and Non-Privately Insured Disabled Elders

The purpose of this study was to collect detailed information on the experiences of long-term care policy holders who have filed insurance claims to receive home care benefits and how their formal and informal service use compares to a comparable population of elderly persons without private insurance. Primary data collection involved face-to-face interviews with approximately 1,000 persons (500 disabled insurance claimants and 500 next-of-kin of those claimants) to collect information on functional and medical characteristics of claimants as well as formal and informal services use. The sample of claimants was drawn from the files of insurance companies that account for the majority of private long-term care policies now in force. Four reports were prepared that contributed to this study: (1) The Use of Nursing Home and Assisted Living Facilities Among Privately Insured and Non-Privately Insured Disabled Elders; (2) Informal Caregivers of Disabled Elders with Long-Term Care Insurance; (3) Multivariate Analysis of Patterns of Informal and Formal Caregiving among Privately Insured and Non-Privately Insured Disabled Elders Living in the Community; (4) A Descriptive Analysis of Patterns of Informal and Formal Caregiving among Privately Insured and Non-Privately Insured Disabled Elders Living in the Community.

FEDERAL CONTACT: Pamela Doty, 202-690-6443

PIC ID: 6399

PERFORMER: Lifeplans, Waltham MA

Understanding Medicaid Home and Community Services: A Primer

Medicaid now offers so many options for providing home and community services that they can be confusing for policymakers, state officials, advocates, and consumers alike. To add to the confusion, the extensive flexibility states have to combine these options has resulted in 50 different state Medicaid programs. This Primer is designed to encourage use of the Medicaid program in a manner that minimizes reliance on institutions and maximizes community integration in a cost-effective manner. It is intended for policymakers and others who wish to understand how Medicaid can be used--and is being used--to expand access to a broad range of home and community services and supports, and to promote consumer choice and control. In addition to comprehensive explanations of program features, states can implement to achieve these goals, the Primer presents examples of state programs that have taken advantage of Medicaid's flexibility to expand home and community services for people of all ages with disabilities. Each chapter of the Primer provides an annotated bibliography, with full information on how to obtain each publication. The next four chapters lay out and discuss the basic elements involved in Medicaid's financial and functional eligibility criteria and service coverage alternatives. The last four chapters focus on key policy goals in the provision of home and community services and supports. It concludes with a series of Appendices that provide additional information about the Medicaid program.

FEDERAL CONTACT: Gavin Kennedy, 202-690-6443

PIC ID: 7162

PERFORMER: George Washington University Medical Center, Center for

Health

Outcomes Improvement Research, Washington, DC

Office of Health Policy

Access and Utilization of New Antidepressant and Antipsychotic Medications

This study was commissioned to identify, document, and assess the factors that affect access to and utilization of new generation antidepressant and antipsychotic medications. It is designed to assist the U.S. Department of Health and Human Services evaluate existing and proposed policies in this area by developing important insights and knowledge concerning the complex processes related to access, utilization, and coverage of newer psychotropic mediations from a variety of perspectives. This study is also designed to identify clinical and health policy issues where further research is needed. The analysis was developed based on published literature, pharmaceutical claims, and primary research with stakeholders. It focuses on antidepressants and antipsychotics as general classes of pharmacotherapy, with emphasis on agents introduced to the US market after 1988. The report's findings are organized into categories, guided by the original principal questions. For example, in terms of access to newer antidepressant and antipsychotic medications, the pharmaceutical benefits are commonly available for psychotherapeutic agents; Limits on prescription coverage and cost sharing requirements apply equally to all classes of medications. In terms of the cost-effectiveness of newer antidepressant and antipsychotic medications, the findings indicate the published cost-effectiveness literature shows no clear differences in total treatment costs associated with the use of different antidepressant agents, although individual studies have claimed that one particular agent is superior to another.

FEDERAL CONTACT: Kevin Hennessy, 202-690-7272

PIC ID: 7193

PERFORMER: The Lewin Group, Fairfax, VA

An Inventory of Federal HIV-Related Databases

Many federal agencies maintain major HIV-related databases. They contain a range of potentially useful information, including epidemiologic and patient-level data as well as health resource utilization, disability benefits, and insurance claims information. However, there is no single inventory that fully describes their study design, data collection methodology, and common and unique data elements. This report is designed to help address this information gap. The resulting resource can be used to catalyze collaborations among government agencies, philanthropies, industry, and academia to increase the understanding of HIV disease and its impact on the health care delivery system. The inventory summarizes the types of HIV-related research supported by DHHS, SSA, and the VA. It describes the major issues addressed by the various studies reviewed in the inventory, their study designs, and their research applications. The inventory includes primarily major studies and databases. The report also identifies selected policy, clinical, evaluation, or other questions that might be the focus of new studies or database development.

FEDERAL CONTACT: Leslie Hardy, 202-690-7858

PIC ID: 7146

PERFORMER: George Washington University Medical Center, Washington, DC

Consumer Protection in Private Health Insurance: The Role of Consumer Complaints

This study provides background lessons for federal regulators who may be required to implement federal patient protection legislation by focusing on consumer complaints about private health insurance in a sample of selected states and major employers. Specifically, the study identified the agencies responsible for health insurance complaints and the availability of complaints data, to review the status of complaints "report cards" and to analyze complaints data as a tool in understanding the implementation of patient protections. A sample of six states (California, Maryland, New York, Oregon, Texas and Vermont) was selected to represent a range of jurisdictional responsibility for health insurance complaints and the existence of ombudsman programs, together with states representing best practice in publication of health insurance complaints report cards. The principal findings include: 1) Jurisdiction over private health insurance complaints varies across states, with responsibility for indemnity health insurance, managed care and quality complaints often split within or between state agencies. 2) There is a wide spectrum in the type of consumer assistance or ombudsman programs available to people with health insurance complaints. 3) There is a hierarchy of complaints handling, with state regulators seeing only the tip of the iceberg in consumer complaints. Across three states for which data were available, the volume of grievances received directly by plans about about seven to eight times greater than the volume of complaints receiped by state regulators.

FEDERAL CONTACT: Bernadette Fernandez, 202-401-8398

PIC ID: 7339

PERFORMER: Health Systems Research, Inc., Washington, DC

Consumer Protection in Private Insurance: State Implementation and Enforcement Experience

The Office of the Secretary for Planning and Evaluation (OASPE) requested this study of state implementation of consumer protections (access to emergency services, network adequacy, continuity of care, standing referral, and access to out-of-network specialists) specifically for the most seriously and chronically ill patients. These protections are sought by people with AIDS, cancer, diabetes, heart disease, and other serious or chronic conditions. This report discusses the experience of four states (Colorado, Maryland, Minnesota, and New York) that have enacted these forms of consumer protection. These states were selected because they had several years of experience implementing most, if not all, of these protections. The report provides a summary of 10 findings, with recommendations for policy direction. The findings from the states indicate those experiences provide a range of approaches that federal regulators can consider when deciding how to implement consumer protection laws. The states also provide potential solutions to implementation challenges that have worked and insights into practices federal regulators may want to avoid because they have not worked well at the state level.

FEDERAL CONTACT: Sarah Shoenecker, 202-401-0882

PIC ID: 7344

PERFORMER: The Lewin Group, Falls Church, VA

Employer Decision Making Regarding Health Insurance

This study provides background lessons for federal regulators who may be required to implement federal patient protection legislation by focusing on consumer complaints about private health insurance in a sample of six states (California, Maryland, New York, Oregon, Texas and Vermont) and major employers. The study sought to identify the agencies responsible for health insurance complaints and the availability of complaints data, to review the status of complaints "report cards" and to analyze complaints data as a tool in understanding the implementation of patient protections. The principal findings are: 1) Jurisdiction over private health insurance complaints varies across states, with responsibility often split within or between state agencies. The lead role is usually taken by state insurance regulatory agencies. 2) There is also a wide spectrum in the type of consumer assistance available to people with health insurance complaints. 3) There is no consistency in grievance data collection requirements across the states. 4) There is a hierarchy of complaints handling, with state regulators seeing only the tip of the iceberg in consumer complaints. Across three states for which data were available, the volume of grievances received directly by plans was about seven to eight times greater than the volume of complaints received by state insurance regulatory agencies. The report does not recommend pursing uniform models of health insurance complaints management, but does recommend that strategies be developed which clarify responsibility, facilitate communication and enhance the knowledge and experience of regulators in complaints management.

FEDERAL CONTACT: Stephen Finan, 202-690-7387

PIC ID: 7338

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

Report to the President: Prescription Drug Coverage, Spending, Utilization, and Prices

In 1999 the President directed the Secretary of Health and Human Services to study prescription drug costs and trends for Medicare beneficiaries. Specifically, he asked that they investigate: (1) price differences for the most commonly used drugs for people with and without coverage; (2) drug spending by people of various ages, as a percentage of income and of total health spending; and (3) trends in drug expenditures by people of different ages, as a percentage of income and of total health spending. This study represents the work of individuals and agencies throughout HHS. Key findings are: (1) Individuals without drug coverage pay a higher price at the retail pharmacy than the total price paid on behalf of those with drug coverage. The differences held up when examining the Medicare and non-Medicare populations. (2) Cash customers pay more for a given drug than those with third party payments at the point of sale. In fact, the typical cash customer paid nearly 15 percent more than the customer with third party coverage. This study presents a detailed examination of multiple factors relating to coverage, utilization, and spending for prescription drugs, particularly by the Medicare population.

FEDERAL CONTACT: Jack Hoadley, 202-401-8401

PIC ID: 7506

PERFORMER: Office of the Assistant Secretary for Planning and Evaluation,

Office of Income Security Policy, Washington, DC

Office of Human Services Policy

Assessment of Major Data Sets for Analysis of Hispanic and Asian or Pacific Islander Subgroups and Native Americans

This is the first of two reports to assess the capability of a number of federal surveys: (1) to provide data on the major subgroups of Hispanic, Asian or Pacific Islanders (API) and on American Indian or Alaska Natives, to analyze the health, education status, and social and economic well being of these groups; (to identify barriers to developing such data; and (3) to identify options for improving the capacity to obtain statistically reliable data about these populations. The report contains information on the applicable sample sizes, and an inventory of existing Federal databases for most of the major demographic, social, economic and health related surveys carried out by or for U.S. Government agencies. Most of the databases consist of surveys that are carried out annually, or at other regular intervals, so that they provide reasonably current statistical information. Two important sources of information were also included: the decennial census and the National Vital Statistics System. the report notes that it is a general reference for a potential audience of analysts and policy makers seeking information on the possible uses of these databases as a source of data on race/ethnic groups of interest, rather than as technical handbooks.

FEDERAL CONTACT: Canta Pian, 202-690-7149

PIC ID: 7199

PERFORMER: Westat, Inc., Rockville MD

Coordination and Integration of Welfare and Workforce Development Systems

This study provides a snapshot of welfare and workforce system coordination in a limited number of sites at a point in time where welfare programs are work-focused and workforce development systems are reorganizing to provide one-stop services to a broad population. As a result, there is an increased interest in coordination between welfare and workforce development agencies and a greater awareness in each other's programs and services. States and local sites selected for this study represented a range of organizational structures, historical experiences, and economic and demographic variables. Cities in these six states were visited- Missouri, Ohio, Oregon, Pennsylvania, Rhode Island and South Carolina. No information collected from clients. The description of client flow and service receipt are developed from discussions with service providers and administrators. There were several key findings: (1) past relationships in implementing previous welfare-to-work programs were important factors in current coordination models and activities. (2) Coordination can occur under a variety of organizational approaches. Different levels of coordination may be appropriate in different communities; (3) Service systems need to fit local conditions. Planners should consider issues of scale--a one-stop with all services in one location works in Dayton, but may not work in a larger city. In some localities, a decentralized, neighborhood-based structure may be more effective.

FEDERAL CONTACT: Audrey Mirsky-Ashby, 202-401-6640

PIC ID: 7144

PERFORMER: Urban Institute, Washington, DC

Dynamics of Children's Movement Among the AFDC, Medicaid, and Foster Care Programs Prior to Welfare Reform: 1995-1996

This report describes pre-welfare reform behavior in order to understand the caseload dynamics around major social programs and provides a baseline for future follow-up. The report traces patterns of children's service use in three programs affected by welfare reform: TANF, Medicaid, and foster care. The data span 1995-1996, the years immediately prior to welfare reform, which was implemented first in 1997. The key findings are: (1) In each of the states less than 3% of children who entered during the study period moved to foster care. However, while this is a small percentage, the majority (60%) of entries to foster care in each of the states were from AFDC and therefore, the small flow from AFDC accounts for a large flow into foster care. (2) Infants are nearly three times as likely to enter foster care from an AFDC spell. This suggests that for young children, there may be a link between the stress or crisis that propels families onto the AFDC rolls and a child's entry to foster care. (3) The numbers participating in AFDC and Medicaid prior to foster care entry suggests that poverty, or perhaps participation in the welfare program, plays an important role in the entry of children into foster care. (4) There was considerable variation in the three states as to patterns of transition of children from AFDC to Medicaid, which suggests that it is unlikely that there will be many similarities in program utilization across the states given the differences. Each state will differ based on its program practices and policies, economy, demographic characteristics and other factors. Each state will have to tailor its plans accordingly.

FEDERAL CONTACT: Laura Radel, 202-690-5938

PIC ID: 7511

PERFORMER: American Institutes for Research, Washington, DC

Evaluating Alternative Welfare-to-Work Approaches: Two-Year Impacts for Eleven Programs

This report analyzes the effectiveness of 11 mandatory welfare-to-work (WtW) programs operated in seven locales: Atlanta, GA, Columbus, OH, Detroit and Grand Rapids, MI, Oklahoma City, OK, Portland, OR, and Riverside, CA. Individuals in these programs did not face a time limit on eligibility for assistance since all the programs studies were pre-TANF. The 11 programs differed in the messages that they sent to welfare recipients about how best to obtain and retain employment. Some stressed getting a job quickly, and others stressed initial investments in basic education or training. Most of the programs imposed a mandatory participation requirement, with several using financial sanctions (i.e., welfare grant reductions) extensively to enforce this mandate. Sample members are being followed for five years from the time they entered the study. This report focuses on adult outcomes, although some information on children's outcomes is provided. The report cites a number of findings, including 1) All programs reduced welfare dependency to some degree; (2) Most programs increased sample members' reliance on earnings, as opposed to welfare, but their families' net incomes were largely unchanged; and, (3) All programs, regardless of their approach, increased participation in activities designed to promote employment during the two-year follow-up period.

FEDERAL CONTACT: Audrey Mirsky-Ashby, 202-401-6640

PIC ID: 7089.3

PERFORMER: Manpower Demonstration Research Corporation, New York, NY

Evaluation of the New York City Homerebuilders Demonstration

In 1993, the New York State Department of Social Services (DSS) and the New York City Child Welfare Administration began testing a new approach to the financing of services to foster children and their birth families based on concepts from managed care. Based on the premise that paying for each day a child is in foster care (per diem payment) is a disincentive to return children home, the demonstration tested an alternativve method of agency reimbursement. Instead of paying for each day in care, agencies were paid a flat amount of money or capitation payments for an identified group of children in foster care. The funds were to be used to serve the children for three years. A projection of care day utilization was calculated based on each agency's historic care day usage. A strategy was agreed upon to pay agencies a percentage of the three-year capitation each year. Funding was front loaded in the first year to encourage early discharge. It was hypothesized that the change in the payment system would achieve earlier permanency for children through intensified discharge planning and aftercare services. Funds could be used for foster care costs and any services the agencies believed would achieve earlier permanency. The initiative included six agencies, using an experimental design involving comparison groups in five of the agencies, with random assignment in three. The new financing mechanism was to be used in the experimental groups while services to the control group were financed under the old system. The purpose of the evaluation was to document the implementation of the program, the services provided, and the outcomes of those services. (See PIC ID 5337 and 5337.1.)

FEDERAL CONTACT: Matthew Stagner, 202-690-5653

PIC ID: 5337.2

PERFORMER: Westat, Inc., Rockville MD

Health Conditions Utilization and Expenditures of Children in Foster Care

This study was funded by the Office of the Assistant Secretary for Planning and Evaluation in the Department of Health and Human Services to inform policymakers of the health care experience of children in foster care who are enrolled in Medicaid, including their demographic characteristics, diagnosed health conditions, and patterns of health care utilization and expenditures. The data source for the study is the State Medicaid Research Files (SMRF) from three states (California, Florida and Pennsylvania) of children under age 19 who received adoption assistance, AFDC, or SSI benefits. The results indicate: (1) Children in foster care accounted for a disproportionate share of Medicaid expenditures (1.1 and 3.3 percent enrolled; 3.6 to 7.8 percent of Medicaid expenditures); (2) Children in foster care had less continuous Medicaid coverage than children receiving SSI benefits and those in families receiving adoption assistance; (3) Children in foster care were more likely than other groups of Medicaid children to have a mental health or substance abuse condition. They had a higher likelihood of comorbidities than AFDC and adoption assistance children, but were less likely than SSI children to have multiple diagnoses; (4) In general, foster care children in California were less likely to receive health care services than those in the other two states. (5) In general, expenditures were highest for the SSI population and second-highest for foster care children.

FEDERAL CONTACT: Laura Radel, 202-690-5938

PIC ID: 7149

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

Impacts on Young Children and Their Families Two Years After Enrollment: Findings from the Child Outcomes Study

This component of the evaluation focuses in depth on children's development and well-being for a sample of families with young (preschool age) children at the start of the evaluation drawn from three of the NEWWS sites: Atlanta, Grand Rapids, and Riverside. The report asks whether young children's development and well-being were affected when their mothers were assigned to participate in Welfare-to- Work (WtW) programs implemented as part of the Job Opportunities and Basic Skills Training (JOBS) Program. This program required mothers of young children as young as age three (or age one, at state option) to participate in WtW activities. The findings indicate that the WtW programs did have significant impacts on children's developmental outcomes, but these impacts were not widespread and were generally small. When impacts did occur, they were favorable in the area of the children's cognitive development and academic achievement, unfavorable in the area of the children's health and safety, and mixed in the area of behavioral and emotional adjustment. Looking at subgroups of families, there was a pattern of favorable impacts for children from higher-risk families assigned to human capital development programs or to the Atlanta labor force attachment program. Yet, at the same time, there was a concentration of unfavorable, and policy relevant, impacts for children from lower-risk families in three of the programs studied.

FEDERAL CONTACT: Audrey Mirsky-Ashby, 202-401-6640

PIC ID: 7089.5

PERFORMER: Manpower Demonstration Research Corporation, New York, NY

Impacts on Young Children and Their Families Two Years After Enrollment: Findings from the Child Outcomes Study – Summary Report

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. This study focuses in depth on children's development and well-being for a sample of families with young (preschool age) children at the start of the evaluation, drawn from three of the evaluation's seven research sites. The results indicate that the welfare-to-work programs implemented as part of the JOBS Program did have significant impacts on children's developmental outcomes, but these impacts were not widespread and were generally small. When impacts did occurs, they were favorable in the area of the children's cognitive development and academic achievement, unfavorable in the area of the children's health and safety, and mixed in the area of behavioral and emotional adjustment.

FEDERAL CONTACT: Audrey Mirsky-Ashby, 202-401-6640

PIC ID: 6576.4

PERFORMER: Child Trends, Inc., Washington, DC

Implementation, Participation Patterns, costs, and Two-Year Impacts of the Detroit Welfare-to-Work Program

This report examines the welfare-to-work programs operated in two of Detroit's welfare districts: and Hamtramck. It describes Michigan Opportunity and Skills Training (MOST), an education-focused program that was in place in these two offices in 1992 at the start of the evaluation, and the transition to Work First, an employment-focused program emphasizing job search services that was implemented in October 1994 and is one component of Michigan's current welfare reform program. This report analyzes data on participation, AFDC and Food Stamp receipt, employment, and earnings. The results are based on a random assignment research design, in which welfare recipients were randomly assigned to one of two groups: the program group, whose members were assigned initially to MOST and were subject to MOST participation requirements; and the control group, whose members were not subject to any participation requirements for three years, but who could seek out, on their own, educational and training programs available in the community, and who were eligible for child care and transportation assistance provided by the MOST office. The report sample consisted of 4,459 single-parent sample members (2,226 program group and 2,233 control group members). The report provides a summary of the results and data depictions of the impact of the MOST and Work First programs.

FEDERAL CONTACT: Audrey Mirsky-Ashby, 202-401-6640

PIC ID: 7089.2

PERFORMER: Manpower Demonstration Research Corporation, New York, NY

Indicators of Welfare Dependence: Annual Report to Congress

The Welfare Indicators Act of 1994 requires HHS to prepare annual reports to Congress on indicators and predictors of welfare dependence. This is the third of these annual reports. The report focuses on benefits under the Aid to Families with Dependent Children (AFDC) program, now Temporary Assistance to Needy Families (TANF); the Food Stamp Program; and the Supplemental Security Income (SSI) program. Selected highlights from the many findings in the report include the following: In 1995, 5.1 percent of the total population was dependent in the sense of receiving more than half of total income from AFDC, food stamps, and/or SSI. The percentage of the population that received AFDC/TANF in 1998 was lower than in any year since 1970. Long term dependency is relatively rare. Only 4 percent of those who were recipients in 1982 received more than 50 percent of their income from these programs in nine or more years over a ten-year period. This represents less than 0.5 percent of the total population. Recipients of AFDC, food stamps, and SSI are less apt to have a family member participating in the labor force than are individuals in the general population. Full-time participation in the labor force has increased among AFDC families between 1993 and 1995, according to Census Bureau data. Other data sources indicate that this trend of increased labor force participation has continued through 1998.

FEDERAL CONTACT: Julia Isaacs, 202-690-6805

PIC ID: 7281.3

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

Oklahoma City's ET&E Program: Two-Year Implementation, Participation, Cost, and Impact Findings

This report presents evaluation results for Oklahoma City's Education, Training, and Employment (ET&E) program, which was designed to promote self-sufficiency among applicants for and recipients of AFDC. The program advocated participation in education, training, and job search classes to enhance the individual's employability and granted child care assistance to support participation in the program and employment. This report's data measure ET&E's operation before it was overhauled in late 1995. At that time, Oklahoma City's program shifted from one that encouraged individuals to build skills through formal education and that put great emphasis on participants' choice to a program that is mandatory and employment-focused, requiring individuals to look for a job first, both before and after their application for welfare is approved. Future NEWWS documents will follow Oklahoma City sample members for up to five years; it is possible that longer follow-up will reflect Oklahoma City's shift to a program type that has produced large effects in other locales. Major two-year findings are: (1) ET&E administrators and staff did not strongly enforce the stated mandate to participate. (2) There was only a slight increase in participation among welfare applicants in training and education activities above what they would have accessed on their own within a two-year period. (3) Less than $1,000 was spent on each program group member, the lowest found for a NEWWS program. (4) ET&E produced no impacts on employment or earnings within two years, but did generate moderate AFDC savings.

FEDERAL CONTACT: Audrey Mirsky-Ashby, 202-401-6640

PIC ID: 7089.1

PERFORMER: Manpower Demonstration Research Corporation, New York, NY

Study of Welfare-to-Work Programs Serving Noncustodial Parents

The Welfare-to-Work (WtW) Grants Program presents an important opportunity for states and localities to provide employment services to noncustodial fathers. In order to assist organizations developing programs for noncustodial fathers, this paper provides information on employment barriers facing these fathers, current and past programs serving this group, and strategies for providing effective services. It finds that the noncustodial fathers targeted by the WtW Grants Program include disproportionately high numbers of poorly educated minorities with limited work experience. The paper provides guidance for assisting these fathers in preparing for and locating stable employment and facilitating their efforts to pay child support and become involved with their families.

FEDERAL CONTACT: Alana Landey, 202-401-6636

PIC ID: 7086

PERFORMER: Mathematica Policy Research & Urban Institute, Washington, DC

The Low-Wage Labor Market: Challenges and Opportunities for Economic Self-Sufficiency

In this report, experts in labor market analysis synthesize the current literature on the low-wage labor market and highlight important policy implications flowing from their review. The nine expert reviews of the literature on the low-wage labor market discuss several challenges to obtaining self-sufficiency in the low- wage labor market and highlight several policy options for improving the wage, employment, and economic self-sufficiency outcomes of low-wage workers such as: (1) Policies to improve labor market access and job retention through continued funding and support for programs that provide labor market information. Services such as child care and transportation are also important. (2) Policies to encourage or support occupational mobility/job advancement. These include developing information networks and policies to encourage businesses to delineate skill requirements and career ladders for entry-level jobs, as well as on-the-job training for such career ladders. (3) Policies to raise the incomes of low-wage workers and enhance employment security. These include the Earned Income Tax Credit, targeted public and community service jobs strategies, and minimum wage policies.

FEDERAL CONTACT: Kelleen Kaye, 202-401-6634

PIC ID: 7425

PERFORMER: Urban Institute, Washington, DC

The Role of Intermediaries in Linking TANF Recipients with Jobs: Final Report

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 is presented for a large number of intermediaries, in general terms, focusing on the basic characteristics of the intermediaries and the types of services provided. The second part of the project presents in-depth information on implementation issues based on site visits to the communities of an urban and rural site in ten states.

FEDERAL CONTACT: Kelleen Kaye, 202-401-6634

PIC ID: 7151

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

Trends in the Well-Being of America's Children & Youth: 1999

This report presents the fourth edition of a collection of national estimates of child and youth well-being. Trends are presented from the 1970s through the 1990s. The report presents the most recent and reliable estimates on more than 90 indicators which have been organized into these five broad areas: (1) population, family, and neighborhood; (2) economic security; (3) health conditions and health care; (4) social development, behavioral health, and teen fertility; and (5) education and achievement. Now indicators for this edition of the report include: arts proficiency for children in grade 8; student computer use. In terms of how children are faring overall, the report highlights indicate: youth violence has been decreasing; the birth rate for teen females ages 15 to 19 continues its downward trend; median incomes of families with children receiving welfare payments decreased steadily since 1993; and the percent of single mothers in the labor force increased from 66 percent in 1996 to 74 percent in 1998. The report also speaks to major gaps in the federal statistical system which contributes to an incomplete picture of the quality of our children's lives. For example, there are few measures of social development and health- related behaviors for very young and pre-teenage children that are measured on a regular basis. There are few indicators available that reflect important social processes affecting child well-being that go on inside the family and within the neighborhood. Other areas in need of measurement development or improvements in the quality, consistency, and frequency of available data include child abuse and neglect, youth violent crime, day care quality, learning disabilities, and measures of children in institutionalized care.

FEDERAL CONTACT: Matthew Stagner, 202-690-5653

PIC ID: 6170.3

PERFORMER: Child Trends, Inc., Washington, DC

Welfare Leavers and Medicaid Dynamics: Five States in 1995

In addition to the unprecedented decline in state welfare caseloads, since 1994, is the decline in Medicaid enrollment for children and their parents. These declines in Medicaid enrollment were not expected, given the many ways family members, especially children, can remain eligible for Medicaid after welfare. There has also been a decline in the number of uninsured. This study analyzed the 1995 Medicaid enrollment patterns of children and their parents in five states to increase our understanding of the enrollment interactions between welfare and Medicaid. One part of the analysis focused on persons who left welfare during the year to see how many stayed on Medicaid. A second part of the analysis looked at the dynamics of overall Medicaid enrollment during 1995, with a focus on the extent of turnover. State Medicaid Research Files (SMRF) from the Health Care Financing Administration (HCFA) are the primary data source. The findings indicate: 1) Declines in state welfare caseloads are associated with declines in Medicaid enrollment, particularly for parents; (2) Many welfare leavers are not staying on Medicaid and are at risk of becoming uninsured; (3) Medicaid programs appear to disproportionately lose low-cost welfare leavers while continuing to cover those with higher costs; (4) States are experiencing considerable turnover in their Medicaid caseloads.

FEDERAL CONTACT: Julia Paradise, 202-690-6476

PIC ID: 7510

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

What Works Best for Whom: Impacts of 20 Welfare-to-Work Programs by Subgroup

During the ten years prior to the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996, large-scale rigorous studies of welfare-to-work (WtW) programs were launched in many states and counties. This report investigates results from 20 of these programs to determine who has benefited from welfare-to-work programs (and who has not) and whether some practices appear more effective than others at increasing the employment and earnings of single-parent welfare recipients. All the programs required some portion of the welfare caseload to participate in a WtW program or risk losing some or all of their welfare benefits through sanctions. The researchers used an experimental research design in which individuals were assigned at random either to a program group, which was required to participate in an employment or training program, or to a control group, which did not have access to the program. The findings are described in brief, including 1) People in the program groups had higher earnings and lower welfare payments than people in the control groups, but generally had the same combined income from earnings, AFDC, and Food Stamps. 2) Employment-focused programs tended to be more effective than education-focused programs for the more disadvantaged groups. Programs that provided a mix of first activities tended to help the broadest range of people.

FEDERAL CONTACT: Audrey Mirsky-Ashby, 202-401-6640

PIC ID: 7089.4

PERFORMER: Manpower Demonstration Research Corporation, New York, NY

Office of Program Systems

Community-Level Indicators for Understanding Health and Human Services Issues

Local governments, private civic improvement organizations, community foundations and private community-based services organizations are beginning to build and use data sets to create local indicator systems that, in turn, have become fundamental tools for tracking and understanding community viability, health and social functioning. The HHS, Office of the Secretary for Planning and Evaluation (ASPE) has a keen interest in partnering with states and localities to further the availability and appropriate use of local- level data. This compendium is a useful tool for achieving that goal. This compendium is a resource for people in local, state and federal government agencies, private sector organizations and others who are interested in learning more about the growing use of community-level social indicators. It is designed as a user-friendly tool that showcases an interesting and diverse selection of indicator systems and resource organizations. It is intended to facilitate information sharing among those who are doing local indicator work and to provide background information for those who are new to this rapidly evolving area of interest. By focusing attention specifically on community-based indicator systems, this publication may also increase awareness of current data resources and inform discussions of strategies for improving the availability, quality and applicability of local indicator data.

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

PIC ID: 7359

PERFORMER: Research Triangle Institute, Research Triangle Park, NC

Food Safety Strategic Elements: Evaluation Synthesis Findings and Research Needs: Final Report

The purpose of this evaluation synthesis is to identify research needs and directions for enhancing our knowledge base in food safety. Using the President's Council on Food Safety's Draft Preliminary Food Safety Strategic Plan, the first step in the process consisted of identifying key elements critical to achieving the draft food safety goals and objectives. While the Council's plan is comprehensive and includes microbial, chemical and physical hazards, this report is limited to microbial hazards. Once the key elements were selected and the research review questions clearly defined, a review was conducted of the scientific research literature related to the policy-relevant question for each of the eight food safety elements. The report is divided into three sections: Section 1 - provides an overview of the report; Section 2 - summarizes the scientific research literature on the eight strategic elements. For each element, a specific research question is stated followed by a summary of key findings from the literature; and Section 3 - provides information on future research needs which constitute the starting point of a two- fold process in developing a food safety research agenda. The first step is the idea-generating and feedback phase. The second step is the development of a process for and the prioritization of the generated list of research needs in line with a strategic plan for food safety.

FEDERAL CONTACT: Paul Johnson, 202-401-8277

PIC ID: 7360

PERFORMER: Research Triangle Institute, Research Triangle Park, NC

In-Progress Evaluations

Office of Disability, Aging, and Long-Term Care Policy

  • A Comparative Study of the Outcomes and Costs Associated with Medicare Post-Acute Services in Skilled Nursing Faciities, Rehabilitation Hospitals/Units
  • Analyses of Changes in Elderly Disability Rates: Implications for Health Care Utilization and Costs
  • Analyses of Residential Transition of Older Americans
  • Analysis of the Disability Supplement to the National Health Interview Survey
  • Case Studies and Technical Assistance for Medicaid Buy-Ins for People with Disabilities
  • Characteristics of Nursing Home Residents
  • Clarifying the Definition of Homebound and Medical Necessity Using OASIS Data
  • Developing Concise Measures of Child Disability
  • Disability Suplements to HCFA Evaluation of Medicaid Managed Care in Tennessee
  • Evaluation of Practice in Care (EPIC)
  • Long Term Care Microsimulation Model
  • Longitudinal Study of Welfare Reform and Its Implications for Persons with Disabilities
  • Managed Delivery Systems for Medicare Beneficiaries with Disabilities and Chronic Illnesses
  • Medicare Post-Acute Care: Quality Measurement
  • Monitoring the Health Outcomes for Disabled Medicare Beneficiaries
  • Personal Assistance Services "Cash and Counseling" Demonstration/Evaluation
  • Research on Employment Supports for People with Disabilities
  • Study of Fair Hearing Adaptations
  • Synthesis of Research on Disability and Managed Care

    Office of Health Policy

  • Assessing Core Capacity for Infectious Disease Surveillance
  • Assessment of Approaches to Evaluating Telemedicine Programs and Projects
  • Comparative Analysis of Decliners of Employer-Based Health Insurance
  • Construction of an Integrated Measure of the Burden of Disease
  • Developing a Framework for Domestic Infectious Diseases Surveillance
  • Development and Validation of a Performance Measure Set for the Evaluation of Medicaid Services Rendered to People with Developmental Disabilities
  • Evaluating the Effects of Direct-to-Consumer Advertising on Consumers
  • Evaluation of Seafood Hazard Analysis Critical Control Point (HACCP) Program
  • Evaluation of the Projects for Assistance in Transition from Homelessness (PATH) Program
  • Factors Influencing Effective Dissemination of Prevention Research Findings by DHHS
  • Follow-Up to Clustering Co-Occurrence Youth Risky Behaviors
  • Impact of Medicare HMO Enrollment on Health Care Costs in California
  • Innovative Coverage of Health Promotion, Clinical Preventive Services, and Other Coverage Issues in the Private Sector
  • Medicare Supplement Insurance: Structure, Change & Implications
  • Preventing Abusive Intimate Relationships Among Adolescents
  • Safety Net Framework Project
  • Safety Net Project: Exploring State Use of Medicaid Disproportionate Share Funds to Enhance Provision of Care to Uninsured
  • State Activity Monitoring Medicaid Managed Care for Children with Special Health Care Needs
  • State Implementation of Immunization Recommendations and Guidance
  • The Changing Structure of Health Insurance Markets
  • Understanding Health Plan Accreditation and Its Potential to Promote the Consumer Bill of Rights and Responsibilities

    Office of Human Services Policy

  • A Research Synthesis of the Findings from ASPE's "Leavers" Grants
  • Abstinence-based Teen Pregnancy Prevention Efforts Targeting Boys
  • Disaggregating the TANF Child-Only Caseload in Three States
  • Domestic Violence and Welfare: An Early Assessment
  • Economic and Health Status of Immigrants, Their Communities, and the Organizations that Serve Them
  • Indicators of Welfare Dependence
  • Low-Income and Low-Skilled Worker's Involvement in Non-Standard Employment
  • National Evaluation of Welfare-to-Work Strategies (NEWWS)
  • Pregnancy Prevention Programs Targeting Boys and Young Men: Policy Information Dissemination Strategy
  • The National Evaluation of the Welfare to Work Grants Program
  • Welfare Outcomes Panel Study
  • Welfare Reform and Changing Program Participation Patterns in Four States

    Office of Program Systems

  • State Telephone Survey Estimates for Evaluation and Monitoring
  • The Importance of Place
  • Trends in Demand for Emergency Assistance Services

Office of Disability, Aging, and Long-Term Care Policy

A Comparative Study of the Outcomes and Costs Associated with Medicare Post-Acute Services in Skilled Nursing Faciities, Rehabilitation Hospitals/Units

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: (1) demographic and health-related characteristics of Medicare beneficiaries who use post-acute services following a hospital stay to determine 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.

EXPECTED DATE OF COMPLETION: 01/20/2004

FEDERAL CONTACT: Jennie Harvell, 202-690-6443

PIC ID: 6836

PERFORMER: Mathematica Policy Research, Inc., Plainsboro, NJ

Analyses of Changes in Elderly Disability Rates: Implications for Health Care Utilization and Costs

The purpose of this project is to conduct analyses using the 1984 to 1999 National Long-Term Care Survey (NLTCS) and the Medicare Current Beneficiary Survey (MCBS) to understand the nature of recent declines in elderly disability rates and their implications for health care utilization and costs. Specifically, researchers are (1) decomposing changes in elderly disability rates using the 1984 to 1999 NLTCS and exploring possible reasons for the decline, and (2) linking changes in elderly disability rates to the use of specific medical procedures (e.g., cataract surgery, coronary and joint replacement surgeries) and/or assistive technology. The MCBS is the primary data set for the latter analyses.

EXPECTED DATE OF COMPLETION: 12/30/2001

FEDERAL CONTACT: William Marton, 202-690-6443

PIC ID: 7554

PERFORMER: Urban Institute, Washington, DC

Analyses of Residential Transition of Older Americans

There are four main questions to be addressed in this project: (1) How do characteristics (both individual and environmental) of elderly persons residing in institutional settings differ from those residing in community-based settings? (2) How do these characteristics vary over time? (3) Are there differences in these characteristics between subgroups of institutionalized and non-institutionalized elderly? (4) What is the relationship between selected individual and environmental factors and the transition of the elderly between community and institutional residential settings? Data from six years of the Medicare Current Beneficiary Survey will be used to answer these questions. Understanding residential transitions will help staff in the Department improve surveys that monitor acute health and long-term care use in different settings (e.g., the Medical Expenditure Panel Survey) and address outstanding long-term care policy issues (e.g., allocation of resources between community and institutional settings).

EXPECTED DATE OF COMPLETION: 03/31/2002

FEDERAL CONTACT: Kamal Hijjazi, 202-690-6443

PIC ID: 7555

PERFORMER: Urban Institute, Washington, DC

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.

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: William Marton, 202-690-6443

PIC ID: 7153

PERFORMER: Urban Institute, Washington, DC

Case Studies and Technical Assistance for Medicaid Buy-Ins for People with Disabilities

In an effort to encourage more states to provide Medicaid to working individuals with disabilities, and to give states addition options for providing Medicaid to those individuals, Congress permitted states to expand their Medicaid programs (through a Medicaid "buy-in") and allow people with disabilities to continue to receive Medicaid services even if they return to work and have earnings greater than 100% of the Federal Poverty Level. The goal of this project is to: (1) examine the early implementation experiences of states that have opted for a Medicaid buy-in for people with disabilities, and (2) offer technical assistance to states on developing cost models, design features of a buy-in, as well as implementation and administration considerations for a buy-in. The project represents a unique opportunity to compare the design and implementation experiences of different states, and use the information gathered to inform both state and federal policy makers about strategies for improving systems that support the employment of people with disabilities.

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Andreas Frank, 202-690-6443

PIC ID: 7556

PERFORMER: George Washington University, Washington, DC

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 provide 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.

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: John Drabek, 202-690-6443

PIC ID: 6275

PERFORMER: Hebrew Rehabilitation Center for the Aged, Boston, MA

Clarifying the Definition of Homebound and Medical Necessity Using OASIS Data

Home health care services are covered in full for Medicare beneficiaries who meet a set of coverage criteria. Though most coverage criteria are straightforward, there is no operational definition to either the homebound or the medical necessity criteria that can be used uniformly by providers and intermediaries. The vagueness of these two criteria led to wide interpretations by and subsequent problems for the Fiscal Intermediaries and providers as well. The purpose of this project is to develop and test a set of uniform and reliable indicators that can be systematically used to document and monitor two Medicare home health care coverage criteria: the "Homebound" and the "Medical Necessity" criteria. The indicators will be linked to items from the Outcome and Assessment Information Set (OASIS) in a decision tree algorithm (or a logic model). Two decision algorithms will be developed for the two criteria. The algorithms will represent a major step toward helping providers, HCFA, and the intermediaries in administering the home health benefit.

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Kamal Hijjazi, 202-690-6443

PIC ID: 7557

PERFORMER: Visiting Nurse Service, New York, NY

Developing Concise Measures of Child Disability

This project will support Network activities related to the development of a set of concise measures of childhood disability. The project will capitalize on recent conceptual and methodological developments in the demographic, social and biomedical study of disability. Specifically, the project will use data from the 1994 and 1995 disability supplements to the National Health Interview Survey (NHIS-D), the 1997 National Health Interview Survey (NHIS), and the 1992 and 1993 panels of the Survey of Income and Program Participation to develop concise measures of disabilities in children. The method of development will use two leading conceptual models of disability: that of the National Center for Medical Rehabilitation Research (NCMRR) and that of the World Health Organization (WHO). The intent of these concise measures is to provide reliable sets of indicators that are sensitive to subgroups of children to be used in population sample surveys and survey-based surveillance systems.

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: John Drabek, 202-690-6443

PIC ID: 7558

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

Disability Supplements to HCFA Evaluation of Medicaid Managed Care in Tennessee

This project adds a disability component to an existing HCFA evaluation of Medicaid 1115 waiver demonstrations in five States, with a focus on the Tennessee evaluation. The study will follow the experiences of SSI disabled children and adults (physically disabled, mentally ill, mentally retarded, or developmentally disabled) enrolled in the TennCare and TennPartners Programs. The project will conduct in-depth qualitative analyses of the State's experience in enrolling individuals with disabilities into managed care systems, and will conduct quantitative analysis to examine cost and utilization data for these populations. The supplement will also include a survey of disabled consumers to examine issues of satisfaction, quality, health status, and functioning.

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Hunter McKay, 202-690-6443

PIC ID: 6166.2

PERFORMER: Mathematica Policy Research, Inc., Plainsboro, NJ

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" has 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 combatting fraud and abuse, as well as contribute valuable data to a future prospective payment system.

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Kamal Hijjazi, 202-690-6443

PIC ID: 5888

PERFORMER: University of Colorado, Denver, CO

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 ability to simulate a wide range of policy options. ASPE will use this computer model for projections and a series of policy simulations which 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.

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: John Drabek, 202-690-6443

PIC ID: 7143

PERFORMER: The Lewin Group, Fairfax, VA

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?

EXPECTED DATE OF COMPLETION: 09/30/2003

FEDERAL CONTACT: William Marton, 202-690-6443

PIC ID: 7362

PERFORMER: Johns Hopkins University, Baltimore, MD

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.

EXPECTED DATE OF COMPLETION: 08/31/2001

FEDERAL CONTACT: Jennie Harvell, 202-690-6443

PIC ID: 6391

PERFORMER: Mathematica Policy Research, Inc., Plainsboro, NJ

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.

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Jennie Harvell, 202-690-6443

PIC ID: 7363

PERFORMER: Urban Institute, Washington, DC

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.

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Pamela Doty, 202-690-6443

PIC ID: 7364

PERFORMER: Laguna Research Associates, San Francisco CA

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) to test the effects of "cashing out" Medicaid-funded personal assistance services for the disabled. The demonstration sites are located in Arkansas, 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.

EXPECTED DATE OF COMPLETION: 09/30/2004

FEDERAL CONTACT: Pamela Doty, 202-690-6443

PIC ID: 6161

PERFORMER: University of Maryland, Center on Aging, College Park MD

Research on Employment Supports for People with Disabilities

Employment rates for people with disabilities have remained low despite advances in legislation (especially the Americans with Disabilities Act), the availability of technology which can assist with everyday activities and work-related functions, and an increase in positive societal attitudes toward the integration of people with disabilities into mainstream social institutions. Only about 25 percent of people with significant disabilities between the ages of 16 and 64 are employed. Most of the policy research on the employment of people with disabilities has relied on statistical data from national surveys. Detailed information on individuals' experiences was needed to augment the survey data. This project will fill that need as it will: (1) gather descriptive data about public and private sector employment programs, (2) examine successful employment supports, and (3) investigate the factors that affect the ability of people with significant disabilities to work. Focus groups, examining the supports important to people with disabilities who are competitively employed, will be conducted in three cities. Policy papers, summarizing the results of the focus groups, will be completed by March 2001. The topics of the policy papers will include: transitions to employment, supports for employment, role of health insurance, role of employers, and supports used by individuals with mental disabilities.

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Andreas Frank, 202-690-6443

PIC ID: 4917.2

PERFORMER: The Lewin Group, Fairfax, VA

Study of Fair Hearing Adaptations

The purpose of this task order is to conduct a qualitative study that describes in detail selected aspects of four adaptations to the Medicaid Fair Hearing process for beneficiaries enrolled in managed care. The adaptions include evidentiary hearings, ombudsman programs, external review organizations and expedited review of appeals. Descriptive information will be gathered through case studies on the mechanics of each adaptation and the perceptions of state Medicaid staff, managed care organization administrators and advocacy organizations regarding issues related to their use by Medicaid beneficiaries. A policy meeting will be held to discuss the project's findings and the potential for using the findings to improve the Medicaid Fair Hearing process.

EXPECTED DATE OF COMPLETION: 11/30/2001

FEDERAL CONTACT: Hunter McKay, 202-690-6443

PIC ID: 7559

PERFORMER: Mathematica Policy Research, Inc., Plainsboro, NJ

Synthesis of Research on Disability and Managed Care

Since the mid-1990s, a number of research institutions initiated projects to assess how well disabled persons are cared for in managed care settings. The research focused on many different aspects of managed care and disability, and used a wide variety of research designs. The purpose of this delivery order contract is to: (1) synthesize recent research on the performance of managed care plans in caring for persons with disabilities, (2) summarize research on current trends in enrollment of disabled persons into Medicaid managed care programs, (3) recommend areas for future research, and (4) convene a small research conference to explore the perspectives of other organizations sponsoring research in this area.

EXPECTED DATE OF COMPLETION: 08/30/2001

FEDERAL CONTACT: Hunter McKay, 202-690-6443

PIC ID: 7560

PERFORMER: Mathematica Policy Research, Inc., Plainsboro, NJ

Office of Health Policy

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.

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Andrea Pernack, 202-690-6860

PIC ID: 7351

PERFORMER: The Lewin Group, Falls Church, VA

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.

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Tom Hertz, 202-690-7779

PIC ID: 7340

PERFORMER: The Lewin Group, Falls Church, VA

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.

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Bernadette Fernandez, 202-401-8398

PIC ID: 7345

PERFORMER: Urban Institute, Washington, DC

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.

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Kevin Hennessy, 202-690-7272

PIC ID: 7142

PERFORMER: The Lewin Group, Fairfax, VA

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.

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Caroline Taplin, 202-690-7906

PIC ID: 7161

PERFORMER: The Lewin Group, Fairfax, VA

Development and Validation of a Performance Measure Set for the Evaluation of Medicaid Services Rendered to People with Developmental Disabilities

Many public policies seek to influence the decisions employers make about whether and how to offer health benefits to their employees. The process of how employers make such decisions, however, is largely unknown. The Office of the Assistant Secretary for Planning and Evaluation convened two panels of senior corporate managers to discuss how firms make decisions about health benefits. The purpose was to help the office formulate a more comprehensive view of employer decision-making by posing common questions to a cross-section of knowledgeable people, and to identify issues that may be empirically measured. The long-term goal is to be able to better determine how public policies affect or influence the decisions made by employers and unions regarding health coverage. The first meeting focused on the "strategic" trends and issues affecting employer health coverage, addressing such questions as, "What is the role of the employer in shaping health care markets?" The second meeting focused on the internal and operational issues of how employers make health benefit decisions, addressing such questions as: "At what level of the corporate structure are health benefit decisions made?" More information can be found in the summary report at this web address: http://aspe.dhhs.gov/health/reports

EXPECTED DATE OF COMPLETION: 09/29/2002

FEDERAL CONTACT: Elizabeth Couchoud, , 410-786-6722

PIC ID: 7391

PERFORMER: Research Triangle Institute, Research Triangle Park, NC

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.

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Susannah Bruns, 202-690-7996

PIC ID: 6343

PERFORMER: Market Facts, Inc., McLean VA

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.

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Laina Bush, 202-260-7329

PIC ID: 7343

PERFORMER: Research Triangle Institute, Research Triangle Park, NC

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.

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Kevin Hennessy, 202-690-7272

PIC ID: 7210

PERFORMER: Westat, Inc., Rockville MD

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.

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Andrea Pernack, 202-690-6860

PIC ID: 7347

PERFORMER: The Lewin Group, Falls Church, VA

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.

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Kevin Hennessy, 202-690-7272

PIC ID: 7349

PERFORMER: Urban Institute, Washington, DC

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.

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: George Greenberg, 202-690-7794

PIC ID: 6889

PERFORMER: Rand Corporation, Santa Monica, CA

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.

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Caroline Taplin, 202-690-7906

PIC ID: 6347

PERFORMER: Partnership For Prevention, Washington, DC

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.

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Stephen Finan, 202-690-7387

PIC ID: 7348

PERFORMER: Alpha Center, Bethesda, MD

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.

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Sandra Howard, 202-690-7778

PIC ID: 6751

PERFORMER: Research Triangle Institute, Research Triangle Park, NC

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.

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Caroline Taplin, 202-690-7906

PIC ID: 7156

PERFORMER: Northwestern University, Evanston IL

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.

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: George Greenberg, 202-690-7794

PIC ID: 7352

PERFORMER: Urban Institute, Washington, DC

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.

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Jennifer Tolbert, 202-205-8678

PIC ID: 7350

PERFORMER: George Washington University Medical Center, Washington, DC

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.

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Amy Nevel, 202-690-7795

PIC ID: 7342

PERFORMER: Research Triangle Institute, Research Triangle Park, NC

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.

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Stephen Finan, 202-690-7387

PIC ID: 7160

PERFORMER: Alpha Center, Washington, DC

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.

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Ellen Bayer, 202-690-7804

PIC ID: 7346

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

Office of 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.

EXPECTED DATE OF COMPLETION: 11/01/2001

FEDERAL CONTACT: Matthew Lyon, 202-401-3953

PIC ID: 7368

PERFORMER: Urban Institute, Washington, DC

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.

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Sonia Chessen, 202-690-8471

PIC ID: 6726

PERFORMER: South Bronx Overall Economic Development Corporation, Bronx NY

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.

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Laura Radel, 202-690-5938

PIC ID: 7188

PERFORMER: The Lewin Group, Fairfax, VA

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.

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Gerald Silverman, 202-690-5654

PIC ID: 6724

PERFORMER: Urban Institute, Washington, DC

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 citizen 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 also be a focus of the study. The project will supplement an examination of existing secondary data with intensive 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 1,650 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.

EXPECTED DATE OF COMPLETION: 12/31/2001

FEDERAL CONTACT: David Nielsen, 202-401-6642

PIC ID: 6747

PERFORMER: Urban Institute, Washington, DC

Indicators of Welfare Dependence

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."

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Julia Isaacs, 202-690-6805

PIC ID: 7281

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

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?

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Alana Landey, 202-401-6636

PIC ID: 7367

PERFORMER: Urban Institute, Washington, DC

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.

EXPECTED DATE OF COMPLETION: 03/30/2002

FEDERAL CONTACT: Audrey Mirsky-Ashby, 202-401-6640

PIC ID: 7089

PERFORMER: Manpower Demonstration Research Corporation, New York, NY

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.

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Linda Mellgren, 202-690-6806

PIC ID: 6766

PERFORMER: Urban Institute, Washington, DC

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 is evaluating the effectiveness of Welfare-to-Work initiatives, including those undertaken by the Welfare-to-Work grantees and by American Indian and Alaska Native tribal organizations.The Deparment of Health and Human Services (DHHS), in conjunction with the Departments of Labor and Housing and Urban Development, has designed an evaluation to address four key questions: (1) What are the types and packages of services provided by Welfare-to- Work grantees? (2) What are Welfare-to-Work program participants’ outcomes regarding employment and family well-being? (3) What challenges are confronted as grantees implement and operate the programs? (4) 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 three main components: (1) a descriptive assessment of all Welfare-to-Work grantees based on mail surveys and site visits; (2) in-depth process and implementation study; and (3) a special process and implementation study focusing on tribal welfare and employment systems.

EXPECTED DATE OF COMPLETION: 10/20/2003

FEDERAL CONTACT: Alana Landey, 202-401-6636

PIC ID: 7147

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

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) examining the appropriate data sources, research designs and statistical methods for analyzing welfare reform outcomes; and (3) identifying 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.

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Susan Hauan, 202-690-8698

PIC ID: 7145

PERFORMER: National Academy of Sciences, Washington, DC

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.

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Laura Feig, 202-690-5938

PIC ID: 7148

PERFORMER: Chapin Hall Center for Children, University of Chicago, Chicago, IL

Office of Program Systems

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.

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: James Scanlon, 202-690-7100

PIC ID: 6420

PERFORMER: National Center for Health Statistics, Hyattsville MD

The Importance of Place

There is a growing body of research documenting the synergistic effect that the configuration of community resources, community values, population demographic, geography, and other factors has on health and human service outcomes. The Office of the Assistant Secretary for Planning and Evaluation is funding the National Academy of Sciences (NAS) to commission a series of papers to synthesize the available research on the relationship between these place-based factors and outcomes in the areas of health, child and youth development, and welfare reform. The papers will identify available data to assess these interactions and make recommendations for a future research agenda. NAS also will convene a workshop of researchers and policy makers from federal, state and local government, academic institutions and private organizations to reflect on the papers and develop and refine an integrated research agenda. The commissioned papers as well as a workshop summary which will include the research agenda will be available for dissemination.

EXPECTED DATE OF COMPLETION: 03/31/2002

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

PIC ID: 7552

PERFORMER: National Academy of Sciences, Washington, DC

Trends in Demand for Emergency Assistance Services

Since 1993, the number of families receiving federally-funded assistance under Title IV-A of the Social Security Act (welfare) has declined by 50%. While many studies have addressed the circumstances of those who have left welfare, little research has examined: 1) the impact that declining caseloads and welfare reform may have on the demand for and utilization of services from the perspective of community- level emergency assistance providers, and 2) reasons for changes in the composition of clients using such services (e.g., increasing over-representation of of single mothers). The Office of the Assistant Secretary for Planning and Evaluation (ASPE) is committed to research in this latter area in order to determine the outcomes of welfare reform. Since 1999, ASPE has carried out an ongoing project to support the efforts of state and local research organizations in examining the question of whether declining welfare caseloads and TANF implementation have led to a shift in the demand and/or utilization of emergency assistance programs, especially those that provide food and shelter, and to explore some of the reasons this may be occurring. Using grant and contract approaches, the analyses rely upon provider data in conjunction with socioeconomic and caseload information over time to describe and understand trends in demand for and use of emergency assistance providers at the state and local levels.

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Walt Leginski, 301-443-3706

PIC ID: 7551

Office of Public Health and Science (OPHS)

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 2000 Evaluation Reports

Assessment of State Minority Health Infrastructure and Capacity to Address Issues of Health Disparity: Final Report

The purpose of this study was to 1) assess the nature and extent of the minority health infrastructure and capacity to address issues of health disparity, especially by race and ethnicity, in nine States, and 2) identify those factors that contribute to, or detract from, the establishment and sustained support for minority health entities at the State level. Site visits and in-depth interviews with key informants (including State legislators, health administrators, program directors, and community based organizations) were conducted in eight States and one territory. OMH’s crosscutting and priority health issue areas were used as the basis for investigating the kinds of activities underway to address health disparities and to facilitate discussions regarding the factors that promote or hinder attention to such disparities. Findings showed that: 1) data on the health status of all racial and ethnic minorities are lacking; 2) membership in OMH’s national Minority Health Network and participation in OMH conferences afford opportunities to learn about strategies to eliminate health disparities; 3) technical assistance on effective or promising strategies for eliminating health disparities would be beneficial; 4) minority health concerns often cross state boundaries and are regional in nature; 5) while primary responsibility for providing health care to members of Federally-recognized tribes rests with the Indian Health Service (IHS), with services administered by the tribes themselves, State health departments, nonprofit groups, and others also provide some health care to these and other AI/AN populations in their jurisdictions; and 6) the availability of resources devoted to addressing racial and ethnic health disparities is critical to the capacity to provide services for racial and ethnic minorities and to meeting the Healthy People 2010 goal of eliminating health disparities. Recommended strategies for addressing racial and ethnic health disparities at the State level included: launching an initiative to assist States in collecting, tracking, and disseminating health data by race/ethnicity; improving intra-and inter-organizational collaborations related to minority health; providing technical assistance to improve state health infrastructures related to policies, programs, and practices on health disparities; sponsoring a forum to ensure that efforts to provide health care to AI/AN populations is coordinated and complementary; and increasing funding for minority health initiatives at the state and local levels.

AGENCY SPONSOR:Office of Minority Health

FEDERAL CONTACT:Gerrie Maccannon, 301-443-5084

PIC ID:7013

PERFORMER: Office of Minority Health, Rockville, MD

Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and choline (2000)

Recommended Dietary Allowances (RDAs) are recognized as the most authoritative source of information on nutrient levels for healthy people. This new series of references extends the scope and application of previous nutrient guidelines. For each nutrient the book presents what is known about how the nutrient functions in the human body, what the best method is to determine its requirements, which factors (caffeine or exercise, for example) may affect how it works, and how the nutrient may be related to chronic disease. This volume presents information about thiamin, riboflavin, niacin, vitamin B6, folate, vitamin B12, pantothenic acid, biotin, and choline. Based on analysis of nutrient metabolism in humans and data on intakes in the U.S. population, the Standing Committee on Dietary Reference Intakes recommends intakes for each age group--from the first days of life through childhood, sexual maturity, midlife, and the later years. This volume also makes recommendations for pregnant and lactating women and identifies when intake of a nutrient may be too much.

AGENCY SPONSOR: Office of Public Health and Science

FEDERAL CONTACT: Kathryn McMurry, 202-401-0751

PIC ID: 6323.1

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

Integrating Environmental Health and Public Health Services: The Changing Role of Local Health Departments

This paper examines the changing role of local health departments in environmental health protection and prevention, highlighting innovative programs in select health departments around the country. This paper is based on work performed under the study, Assessing Changes in Public Health Functions and Policy Issues. As part of this study, Mathematica Policy Research (MPR) conducted two rounds of site visits to 12 local health departments in communities throughout the country. Information was collected on the extent to which health departments were providing the 10 essential services of public health in various programmatic areas. In addition the environmental health director at each health department was interviewed to determine the extent to which each environmental health programs provides the 10 essential services. The results indicate the majority of the environmental health programs concentrate their resources in 2 of the 10 essential services: enforcement of environmental regulations and monitoring and surveillance. There are, however, three areas in which local health departments have been able to offer additional essential services by integrating traditional environmental services into a broader public health context. The first is through the expansion of community education and outreach and the second area is the community-based aspect of diagnosis and assessment of health hazards.

AGENCY SPONSOR: Office of Disease Prevention and Health Promotion

FEDERAL CONTACT: Matthew Guidry, 202-401-7780

PIC ID: 6325.1

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

National Standards for Culturally and Linguistically Appropriate Services in Health Care

In 1997, the OMH undertook the development of national standards to provide a much-needed alternative to the current patchwork of independently developed definitions, practices, and requirements concerning culturally and linguistically appropriate services (CLAS). The purpose was to develop national CLAS standards that would support a more consistent and comprehensive approach to cultural and linguistic competence in health care. The first stage of the project involved a review and analysis of existing cultural and linguistic competence standards and measures, the development of draft standards, and revisions based on a review by a national advisory committee. The second stage focused on obtaining and incorporating input from organizations, agencies, and individuals that have a vital stake in the establishment of CLAS standards. Publication of standards in the Federal Register on December 15, 1999, announced a 4-month public comment period, which provided three regional meetings and a Web site as well as traditional avenues (mail and fax) for submitting feedback on the CLAS standards.

AGENCY SPONSOR: Office of Minority Health,

FEDERAL CONTACT: Guadalupe Pacheco, 301-443-5084

PIC ID: 7260

PERFORMER: IQ Solutions, Inc., Rockville, MD

Office of Minority Health-Resource Center (OMH-RC) Customer Satisfaction Survey: Final Report

The purpose of this project was to implement a Customer Satisfaction Survey that was designed to evaluate the extent to which the Office of Minority Health Resource Center (OMHRC) is reaching objectives that were established by the Office of Minority Health when the Center was formalized. Objectives for the OMHRC were to: 1) Collect and maintain information on minority health resources available from Federal, State, and local organizations; 2) foster relationships and form partnerships with health professionals, health organizations, and others interested in minority health, and 3) facilitate the exchange of minority health information with emphasis on health promotion, disease prevention, and health education. It was found that an overwhelming majority (more than 96%) appreciated materials and referrals from the Resource Center. Westerners were less likely to find expert referrals useful, use the toll- free telephone service, find requested information being delivered timely, and use the Resource Center again. The study also found that Westerners expected less, and received less, from the Resource Center than did Easterners. The source of this difference was traced to the Resource Center being placed and operated on East Coast time. Westerners were limited to five hours of personal contact, during the OMHRC business day. OMH will use these findings to establish a set of recommended improvements that target Westerners and populations that comprise the smaller percentage of its user base (e.g., Asians/Pacific Islanders, American Indians, and health care professionals). Budget increases and re- evaluation of programmatic activities will be pursued accordingly.

AGENCY SPONSOR: Office of Minority Health,

FEDERAL CONTACT: Howard L. Kelley, 301-443-5224

PIC ID: 6244

PERFORMER: Research Triangle Institute, Research Triangle Park, NC

Services Integration: HIV, STD, TB and Substance Abuse - AFeasibility Study for a Demonstration Project

The expanding HIV/AIDS epidemic has shed light on a persistent public healthchallenge: vulnerable individuals with one health or social condition often are simultaneously faced with other conditions or problems. For eample, a person with serious and persistent mental illness may be at risk of HIV transmission and become exposed to multi-drug resistant tuberculosis. The public health challenge is to address the needs of the person--whatever they might be--using multiple, but not always fully linked or coordinated, categorical public health programs and resources. This report proposes a shift in the paradigm from a categorical disease intervention model to an integrated services approach, and offers some practical approaches for pursuing such a shift. The target audiences are local, state, and federal public health officials and elected leaders, and other public health and social service decisionmakers.

AGENCY SPONSOR: Office of HIV/AIDS Policy

FEDERAL CONTACT: Deborah von Zinkernagel, 202-690-5560

PIC ID: 6321

PERFORMER: John Snow, Inc., Boston MA

Where are we with Health Reform and the Health of the Public: Observations from the Field

In 1994, Baker and colleagues presented a framework for examining how the health of the public can be improved during a period of substantial change in the health system. This article reviews Baker's framework for refocusing and reinvigorating public health in an era of change and provides observations of the local changes. The observations are based on 12 site visits to health departments in randomly selected communities that are representative of the U.S. population. Data for this study were collected as part of the Public Health Tracking Study, a collateral study to the Community Tracking Study that is funded by the Robert Wood Johnson Foundation. It was found that many of Baker and colleague's predictions were on target, but others fall short. Most health departments have divested direct service delivery and instead are focusing on population-based activities. The local health department, however, is a leader in providing health information and planning and mobilizing the community around health issues. It was also found that health departments are having difficulty assuring the quality and availability of services for those in need. Lack of enforcement abilities, especially with regard to managed care organizations, limits health departments' ability to influence the quality of care. Assuring services to low-income residents may become even more difficult as questions remain over the stability and commitment of managed care organizations to provide services to the Medicaid population.

AGENCY SPONSOR: Office of Disease Prevention and Health Promotion

FEDERAL CONTACT: Matthew Guidry, 202-401-7780

PIC ID: 6325

PERFORMER: Mathematica Policy Research, Inc., Plainsboro, NJ

In-Progress Evaluations

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.

EXPECTED DATE OF COMPLETION:09/30/2002

AGENCY SPONSOR: Office of Minority Health

FEDERAL CONTACT: Betty Hawks, 301-443-5084

PIC ID: 6674

PERFORMER: Cosmos Corporation, Bethesda, MD

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

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

EXPECTED DATE OF COMPLETION:05/31/2002

AGENCY SPONSOR: Office of Minority Health

FEDERAL CONTACT: Violet Ryo-Hwa Woo, 301-443-9923

PIC ID: 7479

PERFORMER: National Health Law Program, Washington, D.C.

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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Office of Minority Health

FEDERAL CONTACT: Olivia Carter-Pokras, 301-443-9923

PIC ID: 7014

PERFORMER: Office of Minority Health, Rockville, MD

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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Office of Minority Health

FEDERAL CONTACT: Violet Ryo-Hwa Woo, 301-443-9923

PIC ID: 7097

PERFORMER: Development Services Group, Inc., Bethesda MD

National Standards for Culturally and Linguistically Appropriate Services in Health Care

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

EXPECTED DATE OF COMPLETION:09/30/2002

AGENCY SPONSOR: Office of Minority Health

FEDERAL CONTACT: Guadalupe Pacheco, 301-443-5084

PIC ID: 7260.1

PERFORMER: Center for the Advancement of Health, Washington, DC

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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Office of Disease Prevention and Health Promotion

FEDERAL CONTACT: Matthew Guidry, 202-401-7780

PIC ID: 6492

PERFORMER: Partnership For Prevention, Washington, DC

Scientific Evaluation of Dietary Reference Intakes

The National Academy of Sciences, Institute of Medicine, Food and Nutrition Board is conducting a multi- phase scientific evaluation of human nutrient requirements that: (1) evaluates requirements and dietary and supplement intake data for nutrients and non-nutrient food components, (2) develops Dietary 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); micronutrients (9/98 to 12/00) on macronutrients (fat, carbohydrate, protein (9/99 to 6/02).

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Office of Disease Prevention and Health Promotion

FEDERAL CONTACT: Kathryn McMurry, 202-401-0751

PIC ID: 6323

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

Substance Abuse and Mental Health Services Administration (SAMHSA)

MISSION: To improve the quality and availability of prevention, treatment, and rehabilitation services in order to reduce illness, death, disability, and cost to society resulting from substance abuse and mental illnesses.

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 activity (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 2000 Evaluation Reports

Evaluation of the Comprehensive Community Mental Health Services For Children and Their Families Program

The Comprehensive Community Mental Health Services for Children and their Families Program provides grants to improve and expand local systems of care designed to meet the individualized needs of children and adolescents with a serious emotional disturbance and their families. This report presents data from the third year of the evaluation of the children's services program, based on information collected through August 1998 from 22 grantees that were funded for their first of five years of support. The evaluation focuses on programs that established systems of care for approximately 34,377 children and their families. Presented in the report are two types of evaluation data, (1) outcome data based on project site evaluations of a selected group of 200 to 400 children assessed at intake, 6 months, 1 year, and annually thereafter for as long as they remained in the program. Outcome measures examined included an assessment of the child's clinical and social functioning, educational performance, and stability of living arrangements, coupled with an examination of family and child ratings of the services provided; and (2) descriptive data (e.g., demographic information, diagnostic status, functional characteristics, and referral sources) obtained at the time that children entered services.

AGENCY SPONSOR: Center for Mental Health Services

FEDERAL CONTACT: Rolando L. Santiago, 301-443-3808

PIC ID: 7269

PERFORMER: Macro International, Inc., Calverton, MD

In-Progress Evaluations

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.

EXPECTED DATE OF COMPLETION:10/31/2001

AGENCY SPONSOR: Center for Substance Abuse Prevention

FEDERAL CONTACT: Shakeh Kaftarian, 301-443-9136

PIC ID: 6042

PERFORMER: Cosmos Corporation, Bethesda, MD

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.

EXPECTED DATE OF COMPLETION:09/29/2002

AGENCY SPONSOR: Center for Substance Abuse Treatment

FEDERAL CONTACT: Herman Diesenhaus, 301-443-6575

PIC ID: 6739

PERFORMER: Research Triangle Institute, Research Triangle Park, NC

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.

EXPECTED DATE OF COMPLETION:09/29/2001

AGENCY SPONSOR: Center for Mental Health Services

FEDERAL CONTACT: Rolando L. Santiago, 301-443-3808

PIC ID: 7269.1

PERFORMER: Macro International, Inc., Calverton, MD

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.

EXPECTED DATE OF COMPLETION:09/29/2003

AGENCY SPONSOR: Center for Mental Health Services

FEDERAL CONTACT: Rolando L. Santiago, 301-443-3808

PIC ID: 7269.2

PERFORMER: Macro International, Inc., Calverton, MD

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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Center for Mental Health Services

FEDERAL CONTACT: Randolph Frances, 301-443-3706

PIC ID: 4980.1

PERFORMER: R.O.W. Sciences, Inc., Rockville, MD

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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Center for Substance Abuse Treatment

FEDERAL CONTACT: Ron Smith, 301-443-7730

PIC ID: 5994.4

PERFORMER: Caliber Associates, Fairfax, VA

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.

EXPECTED DATE OF COMPLETION:09/30/2002

AGENCY SPONSOR: Center for Substance Abuse Treatment

FEDERAL CONTACT: Ron Smith, 301-443-7730

PIC ID: 6738

PERFORMER: Westat, Inc.

Rockville, MD

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.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Center for Substance Abuse Treatment

FEDERAL CONTACT: Joan Dilonardo, 301-443-8555

PIC ID: 6454

PERFORMER: Brandeis University, Waltham, MA

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.

EXPECTED DATE OF COMPLETION:12/31/2001

AGENCY SPONSOR: Center for Substance Abuse Treatment

FEDERAL CONTACT: Kevin Mulvey, 301-443-9472

PIC ID: 6737

PERFORMER: Johnson, Bassin and Shaw, Inc., Silver Spring, MD

Appendix A - 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 appendix presents the organization and operation of evaluation at HHS. Described first is the definition and basic purposes of evaluation at HHS, followed by information the resources and funding mechanisms used to support evaluations. The last section of the appendix provides more 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 AND PURPOSE 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. As mentioned in the foreword of this report, evaluations 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).

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 HHS’s 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. 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 decentralized—the 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 Administrator—the 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 thePerformance Improvement report series, the Department has focused more attention on the improving the quality of evaluation studies performed every year. The HHS 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 has initiated two evaluation capacity-building projects. The first project was to establish an evaluation consultant Blanket Purchase Agreement (BPA) contract mechanism to assist agency program managers in obtaining short terms assistance in developing evaluation designs or monitoring the performance quality of evaluation contractors. The second project is conducting a department-wide evaluation training needs assessment survey. The results will be available in the fall of 2002.

Dissemination of Evaluation Reports

Maintaining report libraries and distributing information on evaluation results is an important component of HHS evaluation management. The Department’s information and reports on major evaluations is available centrally through the website of the HHS Policy Information Center (PIC), located at the following address: <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 database and electronic report library maintained by ASPE. As an information database 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 project information 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. (back)

Appendix B - Acknowledgement of HHS Officials

Performance Improvement 2001: 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 Planning and Evaluation
    Frank Burns, Director
  • Agency for Health Care Policy and Research
    Office of the Administrator
    Kathleen Kendrick, Planning and Evaluation Officer
  • 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 Policy, Planning and Legislation
    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
    Lyman G. Van Nostrand, Acting 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 Planning and Evaluation (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 Planning and Evaluation (Program Systems). Responsible staff include Mike Herrell, Paul Johnson, and Jim Scanlon. Development and production of the report was supported, under contract, by the services of Susan Belsinger and Marilyn Henry of Sanad Support Technologies, Inc.; Norma Gavin of Research Triangle Institute; and Cheryl J. Mc Donnell of James Bell Associates.

The following persons from HHS agencies contributed to preparing information on evaluation projects:

  • Administration for Children and Families
    • Naomi Goldstein
    • Mary Ann MacKenzie
    • James V. Dolson
  • Administration on Aging
    • David Bunoski
  • Agency for Health Care Policy and Research
    • Elizabeth Levell
  • Agency for Toxic Substances and Disease Registry
    • David Evans
  • Centers for Disease Control and Prevention
    • Nancy Cheal
    • Nancy Chalmers
    • Susan Cleveland
  • Food and Drug Administration
    • Dennis Hill
    • 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
    • Joan Bailey
    • Diane Buckley
  • Office of Public Health and Science
    • Linda Meyers
    • Valerie Welsh
  • Substance Abuse and Mental Health Services Administration
    • George Fitzelle

Appendix C - HHS Evaluation Review Panel and Program Evaluation Review Criteria

The following individuals served on the evaluation review panel that made recommendations of the reports highlighted in chapter II of Performance Improvement 2001: Evaluation Activities of the U.S. Department of Health and Human Services.

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

Leslie J. Cooksy, Ph.D.
Center for Community Development & Family Policy
College of Human Resources, Education, & Public Policy
University of Delaware
Newark, Delaware

Holly Korda, Ph.D., Panel Chair
Evaluation Consultant
Chevy Chase, Maryland

John Kralewski, Ph.D.
Director, Institute for Health Services Research
School of Public Health
University of Minnesota
Minneapolis, Minnesota

Anna Madison, Ph.D.
University of Massachusetts at Boston
Human Services Graduate Program
Boston, Massachusetts

Kenneth McLeroy, Ph.D.
School of Rural Public Health
Texas A&M University
College Station, Texas

Donna Mertens, Ph.D.
Gallaudet University
Washington, D.C.

Joy Quill
C.J. Quill and Associates, Inc.
Annapolis, Maryland

Mary Ann Scheirer, Ph.D.
Evaluation and Social Research Consultant
Annandale, Virginia

Program Evaluation Review Criteria

The following criteria were used by the HHS Evaluation Review Panel to select evaluation reports to be highlighted in the Chapter II of Performance Improvement 2001

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.