URBANÍSTICA
RENFE-TALLERS CAN PORTABELLA
Sub-Goal: Strengthen health systems to support the delivery of quality health services
Measure FY Target Result
25.1: Decrease the number of visits to the emergency room (per 1,000 live ER discharges)1 (Outcome) Out- Year Target 1.54 (FY 2013) Dec 31, 2015 2009 1.54 Dec 31, 2011
25.III.D.1: Develop and ratify uniform and evidence-based guidelines for the treatment of poisoning. (Targets are cumulative.) (Output) 2012 17 Oct 31, 2013 2011 17 Oct 31, 2012 2010 20 17 2 (Target Not Met)
2009 20 17 2 (Target Not Met)
2008 17 17 3
2007
(Target Met)
18 17
(Target Not Met but Improved) 25.III.D.3: Increase percent of inbound
volume on the toll-free number.
(Output) 2012 75% Oct 31, 2012 2011 73.7% Oct 31, 2011 2010 73.7% 75.6% (Target Exceeded) 2009 71% 73.7% (Target Exceeded) 2008 69.3% 70% (Target Exceeded) 2007 63.3% 66% (Target Exceeded)
Efficiency Measures FY Target Result
25. E.1: Decrease application time burden.
(Efficiency) 2012 26.5 hrs Oct 31, 2012 2011 26.5 hrs Oct 31, 2011 2010 27 hrs 25.47 hrs (Target Exceeded) 2009 27.5 hrs 27 hrs (Target Exceeded) 2008 29 hrs 28.9 hrs (Target Exceeded) 2007 29 hrs 29 hrs (Target Met)
1This is a long-term measure with FY 2009 as the first year for which data will be reported. The next year for reporting is FY 2013. 2 Patient management guidelines activities were not done in FY 2009 and FY 2010; therefore the most recent result remained at 17.
3The FY 2008 actual for 25.III.D.1 remained 17 because the final extension on the cooperative agreement expired December 2007, precluding the
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Measure Data Source Data Validation
25.1 National Hospital Ambulatory Medical Care Survey Validated by CDC.
25.III.D.1 HHS National Guideline Clearinghouse Validated by the American Association of Poison Control Centers.
25. E.1 Online grant applications and grantee reports. Data are regularly reviewed by project officers. 25.III.D.3 Telephone billing reports and the National Poison Data System
operated by the American Association of Poison Control Centers.
Validated by HRSA PSC telecom manager and American Association of Poison Control Centers.
INTRODUCTION
The Poison Control Program aligns with HRSA’s goal to improve access to quality health care and services, and HRSA’s related Sub-Goal: to strengthen health systems to support the delivery of quality health services by working to ensure universal access to quality poison control
services. The performance measures to increase calls to the national toll-free number and
develop uniform guidelines are utilized for program strategic planning to ensure that the program is increasing access to comprehensive quality services for the entire population, particularly children who are the most vulnerable to poisonings. The Program provides grants to poison control centers (PCCs) to support efforts made by PCCs to prevent and provide treatment recommendations for poisonings. In addition, strategies used by the Program include
implementing a national media campaign to promote the Poison Control toll free number and developing partnerships with private and public organizations to promote poison prevention. DISCUSSION OF RESULTS AND TARGETS
Goal: Improve Access to Quality Health Care and Services
Sub-Goal: Strengthen health systems to support the delivery of quality health services. 25.1. Decrease the number of visits to the emergency room.
(Baseline - 2002: 2.05 live ER discharges per 1,000)
Decreasing unneeded emergency room visits for poisoning or suspected poisoning will reduce unnecessary utilization of extremely costly resources, and allow those resources to be better utilized for persons in need of them. The first report for this long-term measure will be for FY 2009.
25.III.D.1. Develop and ratify uniform and evidence-based guidelines for the treatment of poisoning.
Having evidence-based guidelines available for use at the poison control centers will improve uniformity and standard care for acute poisoning-related incidents, thereby improving the quality of care. By FY 2007, 17 guidelines had been developed through a cooperative agreement with the American Association of Poison Control Centers. As a result, the FY 2008 target was reduced from 18 to 17 because the final extension on the cooperative agreement expired December, 2007, precluding the grantee’s ability to conduct the extensive work required to
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develop a guideline. Although new goals were established to develop 3 additional guidelines in 2009, the Program did not meet the FY 2009 and FY 2010 targets as it was unable to award a contract to develop the additional guidelines. The cumulative target remains at 17 for
FY 2011. All of the completed guidelines have been reproduced and distributed to the poison centers and are available on the HHS National Guideline Clearinghouse (NGC) website. The Program is focusing on updating the existing guidelines so they remain available on the NGC website and determining whether additional guidelines are warranted. Pending this assessment, the FY 2012 target remains at17 guidelines.
25.III.D.3. Increase percent of inbound volume on the toll-free number.
Public Law 106-174, the Poison Control Enhancement and Awareness Act, mandated the development of a single, national toll-free number to ensure universal access to poison control services. In 2002, the Poison Control Program, in conjunction with the Centers for Disease Control and Prevention (CDC), initiated the Poison Help campaign, a national media campaign to promote the use of 1-800-222-1222. Increasing the use of the national number provides universal access and provides individuals the resource to determine the severity of the exposure and respond accordingly, which has proven to reduce the number of emergency room visits. According to the AAPCC in 2002, the baseline year, 24.6% of callers utilized the new toll-free number. From FY 2007 to FY 2010, the percent of calls to poison centers on the toll-free number exceeded the targets. The FY 2010 actual was 75.6%. The FY 2012 target is 75%. The Program entered into a contractual agreement with Edelman, a public relations firm, to expand the Poison Help campaign. Edelman’s work is expected to assist in making the general population aware of the toll-free poison hotline (1-800-222-1222), which should increase the percent of inbound volume of calls.
25.E.1. Decrease the application time burden of grantees.
In FY 2007, all grantees were required to provide application time burden information as part of their grant submission. The FY 2007 target of 29 hours was met. In FY 2008 the program met the application submission target of 29 hours with a result of 28.9 hours. Likewise, the FY 2009 target to decrease the application submission time burden to 27.5 hours was exceeded with a result of 27 hours. The FY 2010 application time burden target of 27 hours was exceeded with a result of 25.47 hours. The FY 2011 application time burden target is 26.5 hours, 0.5 hours less than the FY 2010 target. The FY 2012 target is also 26.5 hours.
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Measure FY Target Result
25.III.D.2: Increase the number of PCCs with 24-hour bilingual staff.1
(Output)
2012 N/A N/A
2011 5 Oct 31, 2011
2010 5 4 (Target Not Met)
2009 4 4 (Target Met) 2008 4 4 (Target Met) 2007 4 4 (Target Met) 25.E.2: Decrease reporting time burden.
(Efficiency) 2012 N/A N/A 2011 17 hrs May 31, 2012 2010 17 hrs May 31, 2011 2009 18 hrs 2.71 hrs (Target Exceeded) 2008 19 hrs 2 hrs 2 2007 (Target Exceeded) 19 hrs 20 hrs
(Target Not Met)
Measure Data Source Data Validation
25.III.D.2 25.E.2
Online grant applications and grantee reports. Data are regularly reviewed by project officers.
25.III.D.2. Increase the number of PCCs with 24-hour bilingual staff.
According to the American Association of Poison Control Centers (AAPCC), in 2004 only 1 of 62 Poison Control Centers in the U.S. had 24-hour bilingual staff. In order for the Poison Control Program to ensure universal access and serve a larger population, the original goal was to increase the number of PCCs with 24-hour bilingual staff coverage by at least 2 centers per year. In FY 2005, the Program queried all the PCCs and found that 4 provided 24-hour bilingual services. In FY 2006, there remained 4 PCCs with 24-hour bilingual staff although the target was set at 5. In September 2006, HRSA began providing translation services to all PCCs through a service called Language Line. Language Line provides translation services in 161 languages thereby providing a cost effective means for all PCCs to offer 24-hour translation services. Given the challenges with recruiting qualified bilingual health care providers and the successful implementation of Language Line, in FY 2007, the target for this measure was modified to 4. From FY 2007 – FY 2009, the target of 4 was met. In FY 2010, the target was increased to 5 because poison control centers were expanding efforts to recruit and train bilingual
1 In September 2006, HRSA offered translational services to all PCCs through a service called Language Line. Language Line provides
translational services in 161 languages.
2 This information was inadequately reported by grantees. To address this issue, the Program was more specific in the FY 2009 grant application
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poison experts through rotational opportunities. However, the new target will not be met in FY 2010. Because the Program provides the Language Line service to all PCCs and does not require hiring of specific personnel within poison centers, the measure is proposed for retirement in FY 2012. The last year for which data will be reported is FY 2011.
25.E.2. Decrease reporting time burden. (Financial reporting)
A new on-line application and reporting system was implemented in FY 2005 and was fully implemented in FY 2006. This system was designed to simplify data collection by pre-
populating forms with electronic information from previous years, including budget and service data, eliminating the need for grantees to reenter it. The system also eliminates the need for grantees to reenter the same information in different parts of the application. The target was a 5% reduction each year. In March 2005, a limited number of PCCs were queried to determine the number of hours to complete a financial report on grant activities. From this limited query an average number of hours were calculated. The result was 85 hours to complete a financial reporting document.
For 2006, all grantees were required to provide this information as part of their grant submission. Per the grant submissions, the average number of hours to complete a financial reporting
document was 20 (gathered at the end of the grant cycle), far exceeding the goal to reduce reporting time burden of grantees. PCCs were queried again in FY 2007 with the resulting output of 20 hours for submission of financial documents, one hour more than the target. FY 2008 was a new grant cycle (not continuation) with a requirement to report application and financial reporting time annually. However, the submission requirements may not have been specific enough and the grantees misunderstood what year of information they were to submit with their new application. When the program gathered this information, the results (2 hours) indicated that the program substantially exceeded the financial reporting time target of 19 hours. Only three grantees submitted information for the financial reporting time and it is believed that the three grantees submitted this information related to past-due reports. Same year financial status reporting documents are not due at the same time as the application; therefore, the information to be reported needed to be clarified. For FY 2009, the program was more specific in the grant application guidance about reporting FY 2008 financial status reporting time. FY 2009 financial reporting time was 2.71 hours, exceeding the target of 18 hours. The FY 2010 reporting time burden target is 17 hours. The FY 2011 financial reporting time burden target has been maintained at 17 hours.
The lack of standardization of the definition of reporting time across grantees has led to
inconsistent and unreliable data. Despite offering technical assistance to the grantees in person and over the phone and providing clarifying information about the measure in the written grant guidance, the grantees continue to inconsistently report this information. The grantees have also expressed difficulty in assembling this data, primarily due to the complexity and diversity of their organizational structures. Additionally, this information is of limited value to the PCP and to the grantees. This measure is proposed for retirement in FY 2012. The last year for which data will be reported is FY 2011.
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INFRASTRUCTURE TO EXPAND ACCESS TO CARE