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The Department is pleased to present Performance Improvement 1997: Evaluation Activities of the U.S. Department of Health and Human Services--the second annual report documenting the evaluation efforts of all the HHS agencies and offices. The report has three audiences: decision makers, who need information on program results; program managers, who want to know how other service programs are operating and how performance can be improved; and the community of researchers, advocates, and practitioners, who will use the program information and evaluation tools.
The mission of the Department of Health and Human Services (HHS) is to enhance the well-being and health security of Americans by providing for effective health and human services and by fostering strong, sustained advances in the sciences underlying medicine, public health, and social services. To accomplish this mission, the Department manages an array of programs in basic and applied science, public health, child and adolescent development; programs that foster economic self-sufficiency and support working families; and programs that finance health, mental health, and social services.
Our programs are in a continuous state of reinvention and refinement, informed by the knowledge generated through our evaluation program. The Health Care Financing Administration (HCFA), for example, has multiple evaluations under way to understand the effects of Medicaid waivers. Policy makers and program managers at the Federal and State levels will be able to use information from these evaluations as they develop health care policy into the 21st century. HCFA also completed a study this year of hospital units for ventilator-dependent patients, described in the second chapter, that illustrates the usefulness of our evaluation knowledge for the larger health and human services community. The study's cost analysis found that these special units successfully demonstrated an integration of care for seriously ill patients that could hold promise for further application in managed care.
Increasingly, our programs are managed in partnership with State and local governments. Evaluation studies are an important tool for helping these partners improve program effectiveness. For example, the Centers for Disease Control and Prevention (CDC) assisted the State of Georgia by examining the effectiveness of a new audit method to improve childhood immunization rates. The study showed that the audits contributed significantly to the State's increase in child immunization rates (from 31 percent to 90 percent between 1994 and 1996). Georgia's audit method has been adopted with substantial success in Colorado, Illinois, and South Carolina. Another example is an evaluation by the Administration for Children and Families that helps States implement the child support guidelines established by the Family Support Act of 1988. This study led to greater consistency of guideline application in such areas as health insurance and day care expenses used in determining child support awards.
Performance Improvement 1997 contains information on projects completed in fiscal year (FY) 1996, HHS agency and office evaluations in progress, and future directions for evaluation. The report is organized into three chapters. Chapter I describes the organization of HHS evaluations--activities, resources, planning and management, and future directions. Chapter II highlights the results from 11 FY 1996 evaluations, selected for their potential application by the health and human services community. Chapter III presents the evaluation activities of the 11 HHS agencies and the Office of the Secretary, including information on their evaluation programs, evaluations completed in FY 1996, evaluations in progress, and future directions. A complete inventory of the 87 HHS evaluation projects completed in FY 1996 is provided in appendix A, and the HHS agency projects currently in progress are listed in appendix B.
Performance Improvement 1997: Evaluation Activities of the U.S. Department of Health and Human Services describes the continuous efforts of the various agencies of the Department of Health and Human Services (HHS) 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:
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 Susanne A. Stoiber, Deputy Assistant Secretary for Program Systems. Responsible staff included Mike Herrell, Paul Johnson, Colleen Monaghan, Tricia Quiller, Carolyn Solomon, and Joan Lee Turek. Development and production of the report were supported, under contract, by the services of Deborah Burke, Lydia Paddock, and the staff of EEI Communications.
Performance Improvement 1997 is the second annual report of the U.S. Department of Health and Human Services (HHS) on its evaluation activities. As a report to Congress, it summarizes the findings of HHS evaluations completed in fiscal year (FY) 1996. In that year, HHS agencies produced 87 evaluation reports and supported more than 250 evaluation projects in progress.
In general, the report is intended for three audiences: decisionmakers, who need information on program results across the broad spectrum of health and human services; program managers, who need information on how they can improve program operations and outcomes; and the health and human services community, which can benefit by applying the knowledge and lessons learned from HHS evaluations.
In the Foreword, Secretary Donna Shalala and David Garrison, Principal Deputy Assistant Secretary for Planning and Evaluation, stress that evaluation is an important tool for producing the knowledge necessary to develop and improve the performance of HHS's activities to meet the needs of the 21st century. HHS program managers are continuously engaged in efforts to determine whether programs and services reach the intended populations or communities, perform efficiently, and achieve desired results.
Chapter I provides an overview of evaluation at HHS. It describes a variety of evaluation activities; sources of funding; and evaluation management policies, including planning and coordination, project management, quality assurance, dissemination, and effective use of results. The last section in this chapter discusses future directions for HHS evaluation. In the coming years, the Department will examine the transformations now taking place in health and human services. The transformations underscore the need of the Department to play a leadership role in developing performance measures for implementation of the Government Performance and Results Act of 1993 (GPRA). HHS agencies remain committed to seeking information to continuously improve the operation of their programs.
Chapter II highlights 11 evaluations completed during FY 1996 and identified by the panel of Senior Editorial Advisors as particularly useful to the public health and human services community. For the selection criteria, see appendix C.
This Administration for Children and Families (ACF) Office of Child Support Enforcement report evaluates different forms of interventions to bring noncustodial parents closer to their children after divorce and separation. The interventions included mediation, parenting training, counseling, enforcement of visitation, and monitoring of visitation. The report found that mediation where both parties attend resulted in parenting plans in 65 to 70 percent of the cases. These parenting plans stimulated more visitation by noncustodial parents and better compliance with child support. A majority of both parents were satisfied with mediation. Other forms of intervention for more longer term and problematic cases did not register impact.
This ACF report evaluated the implementation of State child support guidelines mandated by the Family Support Act of 1988. The investigation concluded that States need to increase the consistency of guideline application, including income verification procedures, extended custody and visitation arrangements, and consideration of multiple family situations, health insurance, and day care expenses in the calculation of child support awards. Adopting a standardized support order would improve documentation of departures from guideline award calculations.
The Elderly Nutrition Program sponsored by the Administration on Aging provides grants to State units on aging to subsidize the provision of daily meals to people 60 years of age or older. This evaluation report describes participant characteristics, compares the characteristics of recipients of home-delivered meals with those receiving meals in congregate settings, assesses how well the program reaches disabled and poor elderly, estimates the impact on nutritional intake and social contacts of participants, and examines program costs and other sources of funding. Findings suggest that participants have higher daily intakes of nutrients and more social contacts per month than a comparable group of nonparticipants. The Elderly Nutrition Program succeeds in targeting older people who are poor, live alone, are nutritionally "at risk" because they are overweight or underweight, or are more functionally disabled than their age-group peers. Federal expenditures were found to be highly leveraged with State, local, and private funds.
The final report on the Agency for Health Care Policy and Research (AHCPR)-supported Oregon Consumer Scorecard Project describes the Oregon Consumer Scorecard Consortium's development, pilot testing, and revision of a user-friendly guidebook, "A Consumer Guide to Selecting a Health Plan." The prototype scorecard was designed to help consumers choose a health plan consistent with their individual needs and their health care service delivery preferences. The model may also help purchasers and State policymakers develop their own comparative reports about health plan performance.
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