 |
 |
|
|
|
|
|
|
|
||
|
Office of the Director
|
|
|
||||||
FY 2000 Performance Plan
Revised Final FY 1999 Performance Plan
January 15, 1999
This is a single-file HTML version of this document formatted to
facilitate printing. (Length: approximately 90 pages)
For online viewing, see the multi-file version. An
Adobe Acrobat™ (PDF) version (File size: 599 kb) is also
available.
Contents
Appendix A: Key Improvements in the CDC FY 2000 Performance Plan
I. Overview of the Centers for Disease
Control
and Prevention
The Centers for Disease Control and Prevention (CDC) is the lead federal agency responsible for promoting health and quality of life by preventing and controlling disease, injury, and disability. CDC accomplishes its mission by working with partners throughout the nation and the world to monitor health, detect and investigate health problems, conduct research to enhance prevention, develop and advocate sound health policies, implement prevention strategies, promote healthy behaviors, foster safe and healthy environments, and provide public health leadership and training.
A unique and critical aspect of CDC's leadership role is embodied by its National Center for Health Statistics (NCHS). NCHS provides STRONGleadership in monitoring the health of the American people and is an unparalleled resource for health information. NCHS performs several key roles including providing a solid information base for designing and tracking prevention programs, identifying health problems and risk factors that affect the population, and monitoring the dramatic changes taking place in our nation's health care system. NCHS represents an investment in broad-based, fundamental public health and health policy statistics that meets the needs of a wide range of users within the public health community, the Department, other Federal Agencies, research institutions, and health care practitioners.
CDC's reliance upon and access to existing data is exemplified by its approach to public health problems. In order to address these problems, CDC uses a reliable, proven, flexible four-step process that adapts to the wide variety of problems that are subjects of CDC programs: infectious diseases, environmental and occupational health, injuries, and chronic diseases. This public health approach consists of detecting and defining a problem through surveillance, determining the causes, developing and testing potential strategies for handling the problem, and implementing nationwide prevention programs. The approach is supported by science, and is reflected in CDC's programs, as well as its evaluation of programs. Prevention effectiveness has been institutionalized as a public health science at CDC. Since 1992, CDC has substantially increased its ability to scientifically assess the prevention effectiveness of its programs and strategies. More than ever, CDC is able to prove that prevention is a sound and solid investment. Yet, even as the U.S. health care budget approaches $1 trillion, only 1 percent of health expenditures support population-based prevention.
CDC's distinguished history of success in disease prevention has spanned 51 years, beginning with the first national disease-elimination strategy used against malaria in 1947. Some well-known accomplishments of the Nation's prevention agency resulting from the more than 3,000 investigations of disease outbreaks include identifying Legionnaires' disease and toxic shock syndrome, Reye's Syndrome, Ebola, hantavirus, and many foodborne and waterborne diseases. CDC's "Disease Detectives" are renowned worldwide for their ability to work with local authorities responding to urgent health threats by aggressively investigating outbreaks of disease or injury, identifying ways to stop transmission, and preventing further occurrence. Each year CDC is instrumental in accurately tracking influenza strains around the globe, and as a World Health Organization Collaborating Center, using sophisticated techniques to provide scientific data essential for vaccine development. As part of a global partnership, CDC played a major role in the worldwide eradication of smallpox in 1977 and, as a partner in massive immunization campaigns, is on the verge of globally eradicating polio. In addition, CDC is making steady progress toward eliminating measles. In this country, vaccine-preventable childhood diseases such as measles, mumps, rubella, pertussis, and diphtheria occur at the lowest rates ever seen. CDC's sentinel surveillance permitted early identification of the AIDS epidemic, thus allowing prevention strategies to be formulated and applied to curtail the frightening growth of this epidemic. Today, CDC works with state, community, national, and international campaigns to prevent and control human immunodeficiency virus infection (HIV), sexually transmitted diseases, and tuberculosis (TB).
As the Nation approaches the 21st century, CDC has embarked on a mission of preventing and controlling the Nation's new leading killers, adapting the epidemiologic and laboratory techniques that have proved successful with infectious diseases, while continuing to battle emerging and re-emerging infectious diseases. Chronic diseases, including heart disease, cancer, and diabetes, now cause more than 70 percent of the deaths in the United States (U.S.), a dramatic shift from the beginning of the 20th century when infectious diseases caused most premature deaths. Early diagnosis saves money as well as lives, and research documents that healthy behavioral choices in diet and physical activity can significantly reduce the incidence of many chronic diseases. For this reason, many of CDC's programs approach prevention by targeting the underlying causes of disease, disability, and injury. These underlying factors have been termed the "actual causes of death" and their toll on the health of Americans is significant.
|
For example, CDC's chronic disease prevention strategy is based upon behavioral interventions designed to reduce the underlying causes of chronic diseases. These programs incorporate behavior modification and education to assist the public in efforts to stop smoking, follow a healthier diet, and increase their level of physical activity. Similarly, injury prevention programs rely upon the adoption of prevention practices--the use of seat belts and bicycle helmets, for example. Health promotion and behavior modification are also central to CDC's HIV and sexually transmitted disease programs. Reductions in HIV and sexually transmitted diseases are being achieved through drug education and promotion of safe sex practices, including abstinence. CDC's programs have been strategically grouped into appropriate Centers, Institute, and Offices (CIOs) to more effectively address these factors.
Environmental and occupational health threats also have increased, and CDC's role includes addressing the public health aspects of toxic exposures and occupational diseases, injuries and disabilities. CDC's vision of "Healthy People In a Healthy World Through Prevention" means working with partners to prevent the leading health threats confronting Americans.
A key partner in these efforts is the Agency for Toxic Substances and Disease Registry (ATSDR). In 1983, the Secretary of the Department of Health and Human Services (DHHS) established, by Administrative Order, ATSDR as an agency within the Public Health Service located at the CDC headquarters in Atlanta, Georgia. ATSDR was created to address the health related sections of the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA), or what is more commonly known as "Superfund" legislation. In June 1985, ATSDR was formally organized as an independent agency. By implementing the programs that support its mission, ATSDR forms a critical link among environmental public health, research, and regulatory organizations.
ATSDR, in concert with CDC, the Environmental Protection Agency (EPA), and the National Institute of Environmental Health Sciences (NIEHS), supports CERCLA, one of the most challenging and innovative environmental laws relating to public health. The coordination and collaboration among these environmental public health organizations strengthen the Nation's capacity to understand and respond to environmental public health concerns.
Because ATSDR carries out a unique mission, separate and distinct from CDC's, a performance plan specific to ATSDR's programs and activities has been created and submitted separately from this plan.
Public health and CDC contribute significantly to Americans' ability to lead longer, healthier lives. An infant born today in the United States has 30 more years of life expectancy than in 1900. Twenty-five of these years are directly related to public health efforts. Many public health efforts result in considerable financial savings; others carry a net cost but represent an important investment--and the saving of lives. Clear evidence, for instance, shows that comprehensive health education in schools is effective in reducing risk behaviors among youth, which account for most of the health problems among young people that will follow them into adulthood if not prevented or solved. Such education is also cost-effective: for every $1 spent on tobacco, drug, alcohol, and sexuality education, $14 are saved in avoided health care costs. The signature feature of CDC's public health programs is that they achieve results and cost savings through the promotion of health and quality of life by preventing disease, disability, and injury.
II. Strategic Planning: A Foundation for
Performance Measurement
In June 1995, CDC launched an agency-wide strategic planning process to refocus the organization's priorities, directions for the future, and assess constituents' requirements. Even though this process was initiated to satisfy the requirements of the Government Performance and Results Act (GPRA), the director of CDC decided to conduct full-scale strategic and performance planning to ensure that CDC continues to be a leader in public health policy and practice. This annual performance plan builds upon those efforts.
The agency used its document published in 1994, "Strategic Thinking at the Centers for Disease Control and Prevention," as a foundation for continuing strategic planning at CDC and to move the agency forward into the 21st century. To continue the process, CDC reconfirmed that the vision and mission statements contained in the 1994 document were still valid.
Vision: "Healthy People in a Healthy World--Through Prevention"
The CDC vision conveys an idea of what the world would be if CDC's health promotion and disease prevention goals were fully achieved. The agency is committed to helping create a safe physical and social environment where health is both protected and promoted nationally and internationally. CDC believes that prevention is the foundation for achieving this vision.
Mission: To promote health and quality of life by preventing and controlling disease, injury, and disability.
CDC's mission statement succinctly states how the agency approaches its responsibilities as the nation's prevention agency. Accomplishing this mission is predicated on CDC's ability to build on the following agency strengths:
Strategic Agency Goals
During a one-year period that began in mid-1995, the CIOs of CDC engaged in a planning process that involved their stakeholders and employees in identifying strategic issues for CDC. The agency-wide goals were intended to be broad and all-encompassing. Because CDC's opportunities and responsibilities are often determined by societal changes and environmental events, as opposed to planned internal actions, the goals had to project a broad, overarching approach that relates the agency's programs to the public health community and to the public in general. Under each goal statement, strategies were articulated to elaborate the goal statement as well as describe ways to achieve goals.
The CDC Strategic Framework was developed in the following way: Actions needed to achieve the agency goals were drafted by the CIOs in the form of strategic (five-year) and annual goals. Annual goals represented the first year of achievement of the five-year goal. Performance measures were also developed by the CIOs for both strategic and annual goals. Specific, measurable objectives were developed to support CIO strategic and annual goals.
Healthy People 2000 goals and objectives serve as a foundation for a number of CDC's performance measures. However, it should be noted that although CDC has lead responsibility for many of the objectives contained in Healthy People 2000, achievement of the goals represents a national effort in which CDC partners with other federal, state, local, and community public health entities. Therefore, performance measures within CDC's plan have been crafted to reflect the collaborative nature of CDC's program activities.
Below are the four strategic goals that capture the direction for CDC over the next five years. Each goal statement is followed by a brief presentation that associates the CDC goals and strategies with CDC's budget program activities. Resources required to achieve these activities have been submitted as part of CDC's budget submission.
Goal 1 Science: Assure a strong science base for public health action.
The applied techniques of epidemiology, laboratory, behavioral, and social sciences are the primary tools that CDC uses to understand the causes of poor health, identify populations at risk, and develop interventions for disease control and prevention. As research provides more information about the relationships between the physical, mental, and social dimensions of well-being, a broader approach to public health has become important in the quest for answers to prevent and solve health problems. CDC is committed to expanding its research agenda to help bridge the gap between research and public health practice. Through the integration and communication of scientific information, the most effective public health solutions will be translated into practice in the Nation's communities. Sound public health policy decisions are based on excellence in science and provide the means to achieve the best results.
Program
Activities and Strategies for accomplishing Goal 1
CDC's strategy for assuring a STRONGscience base for public
health action requires an agency commitment to support and conduct high quality
epidemiologic, laboratory, behavior, and social science research. Through its
programs in Environmental Health, Infectious Diseases, Occupational Safety and
Health, Epidemic Services, and the Prevention Centers, CDC advances the science
base in public health by conducting and supporting both extramural and
intramural research on a wide range of public health issues. For FY 2000,
research on several major public health issues will be conducted in order to
improve decision making, to examine health outcomes, or to prevent disease. To
ensure the scientific foundation of public health practices, CDC is continuing
to coordinate the development of the Guide to Community Preventive Services.
This Guide will provide public health practitioners, their community
partners, and policy makers with evidence-based recommendations for planning and
implementing population-based services and policies at the community and state
level.
Goal 2 Assessment: Detect and assess threats to public health.
The wisdom and legitimacy of public health decisions are crucially affected by the quality of the information on which they are based. A unique role of CDC is to provide comprehensive information on health including health status, health risks, the health care system, and health-related outcomes. By maintaining a broad-based monitoring capability, CDC can quickly detect and assess public health threats. CDC's assessment capability, epidemiologic and laboratory surveillance, and response capacity ensure a system that identifies health problems and deploys teams of experts to help resolve the problems promptly. Additionally, the assessment and surveillance capacity ensures data for analysis that can help identify causes of disease early and assist in decisions about appropriate research, policy, and programmatic actions.
Program Activities and Strategies for
accomplishing Goal 2
To accomplish this goal, emphasis will be on assuring that
CDC's surveillance and health information systems address current health issues
and problems and that existing and new CDC data systems are carefully
coordinated and integrated. CDC's Health Information and Surveillance Systems
Board stimulates and sponsors innovation in health information and surveillance
systems supportive of the essential public health services. In addition,
epidemiologic and laboratory capacity for surveillance and response will be
strengthened. Making health information available to a wide audience is a major
CDC priority that requires adjustments to existing data and surveillance systems
and modifications of the procedures for accessing information. For FY 2000, this
goal is accomplished through many of CDC's program activities, with emphasis on
Health Statistics, the Preventive Health and Health Services Block Grant,
Epidemic Services, and Cancer Registries.
Goal 3 Policy: Provide leadership for the nation in prevention policy and practice.
As the emphasis in responsibility for public health services moves from the federal level of government to local governments, CDC will continue in a crucial public health role. CDC's leadership in prevention policy can and should help focus scientific and professional expertise in setting national public health policy. CDC also encourages actions on the part of other federal, state, and local agencies, tribal nations and private organizations to aid in the reduction of threats to health and the promotion of good health. Public health leadership includes the provision of funds and technical assistance, the development of national health data, the conduct of research, and the development of policies and practices that are shaped by science. Through these mechanisms, CDC assures that the public's interest is best served by the measures and programs that are adopted. CDC's role in policy development includes communicating with all affected parties, considering the long-term effects of policy decisions, and speaking for persons or groups who have difficulty being heard.
Program Activities and Strategies for
accomplishing Goal 3
The strategy to address this goal requires CDC to commit to
systematic planning and evaluation of its programs and products and when
feasible to document the costs and benefits of prevention programs. The
establishment of a mechanism for continuous review and feedback on the science
produced in and through CDC-funded projects is an important means for improving
the overall effectiveness of the agency. The processes of planning, evaluating,
peer reviewing, and providing feedback assure that the research standards and
policy guidelines developed by CDC provide current and reliable information for
use in health promotion and disease prevention programs. To augment this
process, CDC is developing a framework for evaluation in public health practice,
an activity that will encourage combining the science of evaluation with the
demands of program management. This framework, to be completed in FY 1999, will
enhance the capacity of health officials to use evaluation as an ongoing means
to improve the quality and test the effectiveness and efficiency of health
promotion and disease prevention work.
Goal 4 Assurance: Assure the public's health through the translation of research into effective community-based action.
This goal is oriented toward developing the capacity of public health departments to carry out essential public health programs and services, and involve community institutions and community groups in health promotion and disease prevention. As CDC strengthens its ongoing relationships with state and local health agencies, it is also committed to building partnerships with non-governmental organizations at the community and national levels. These partnerships are essential for the design, implementation, and evaluation of sound prevention programs. What people understand about their health and potential risks to their health is of major concern in public health. CDC is committed to promoting effective health communication, conveying information to appropriate populations, and facilitating access to health information. The agency seeks to enhance the public's health knowledge through communication that is congruent with the values of diverse communities.
Program Activities and Strategies for
accomplishing Goal 4
To accomplish this goal, a major emphasis must be placed on
expanding CDC's partners to reflect the diversity of the nation. The role and
influence of the community are vital when designing, implementing, and
evaluating public health intervention strategies. There are many areas where CDC
is building the capacity of its partners to carry out important public health
programs. Through state and local health departments, prevention and control
programs focus on the reduction of sexually transmitted diseases, HIV/AIDS,
tuberculosis, vaccine preventable diseases, breast and cervical cancer,
diabetes, injuries, and childhood lead poisoning. In FY 2000, CDC will continue
its efforts in the training of public health leaders in the science of public
health practice. Training efforts in this area are critical in addressing future
public health issues. For example, the CDC-sponsored Public Health Leadership
Institute is an ongoing program that develops the leadership skills of public
health officials at the Federal, State, and local levels.
III. Organization of the Performance Plan
This document represents CDC's Final Revised FY 1999 Performance Plan and the CDC FY 2000 Performance Plan. As indicated in the Performance Measure charts, the FY 1999 measures represent actual targets for FY 1999 based on appropriated funds. The FY 2000 Performance Measures are estimates of CDC's targets based on FY 2000 requested funds. Any changes in the FY 1999 performance measures from previous submissions are based on appropriated funding levels unless otherwise noted as a footnote within the performance measurement tables.
The following performance plan discusses performance objectives and measures by functional areas. The plan is organized in this way to provide the reader with an understanding of how programs within the agency complement and relate to one another. Diverse centralized support services are provided to all program areas, crossing program activity lines. In developing performance measures for non-centralized services, we attempted to link objectives and measures to the program activity lines and provide outcome measures whenever possible. However, we also looked at programs realistically, taking factors into consideration that may have an effect on performance measures. These factors included:
IV. Infectious Diseases
Once expected to be eliminated as a public health problem, infectious diseases remain the leading cause of death worldwide. In the U.S. and elsewhere, infectious diseases increasingly threaten public health and contribute significantly to the escalating costs of health care. They are a continuing menace to all segments of society, regardless of age, gender, lifestyle, ethnic background and socioeconomic status. Earlier predictions of the elimination of infectious disease did not take into account changes in demographics and human behaviors and the extraordinary ability of microbes to adapt, evolve, and develop resistance to drugs. As early as the 1950s, penicillin began to lose its power to cure infections caused by Staphylococcus aureas, a common bacterium that can cause serious illness. In 1957 and 1968, new strains of influenza emerged in China and spread rapidly around the globe, and in the 1970s there was a resurgence of sexually transmitted diseases. Also during the 1970s, several new diseases were identified including Legionnaires' disease, Lyme disease, toxic shock syndrome, and Ebola hemorrhagic fever. Between 1973 and 1995, thirty newly emerging infectious diseases were identified, including hepatitis C virus (HCV) infection, now shown to be the most common bloodborne infection in the U.S. The re-emergence of diseases such as TB, malaria, rabies, dengue, and growing drug resistance of many pathogens continued to dramatically change the global and domestic landscape of infectious diseases. By the early 1990s, it had been demonstrated that the threat of infectious diseases was increasing in the United States and elsewhere.
Emerging Infections
In 1994, CDC began working with other federal agencies, state and local health departments, and other partners to strengthen our Nation's capacity to recognize and respond to infectious disease threats through implementation of the CDC plan, Addressing Emerging Infectious Disease Threats: A Prevention Strategy for the United States. The effort to build U.S. capacity to combat infectious diseases is well underway. However, the fulfillment of CDC's vision of a safer world in the next millennium requires a long-term commitment and sustained effort. The second phase of CDC's effort, Preventing Emerging Infectious Diseases: A Strategy for the 21st Century, has involved taking into account new challenges and building on experience, success, and knowledge gained from the initial plan.
The National Center for Infectious Diseases' (NCID's) performance plan continues to evolve, not only to reflect updated strategies, but to address the challenges posed by new and resurgent infectious disease threats. For example, the recent recognition of an avian strain of influenza in Hong Kong raised the specter of an influenza pandemic. Such a pandemic will have a high death rate, carry with it a huge economic burden, and create massive disruption of public life. A Hepatitis C Virus (HCV) epidemic affecting almost 4 million Americans of whom about 7% may have acquired their infection through blood
transfusion, has also been recognized. The emergence of drug resistance in bacteria, parasites, viruses, and fungi is swiftly reversing advances of the previous 50 years. As we approach the 21st century, many important drug choices of the treatment of common infections are becoming increasingly limited and expensive, and in some cases, nonexistent. This year's performance plan has been updated to include major program efforts for HCV infection, antimicrobial resistance, and bioterrorism. The bioterrorism component of infectious diseases builds on the epidemiologic and laboratory enhancements for emerging diseases, focusing on targeted bioterrorism and unknown threat agents, including weapons of mass destruction (WMD). It strengthens surveillance through a national network of State and major metropolitan area laboratories for early identification and characterization of disease outbreaks.
CDC's efforts focus on building epidemiology and laboratory capacity, recognizing that at STRONGpublic health infrastructure will lead to improved surveillance, a better understanding of disease determinants, interventions, that will prevent and control disease outbreaks, and ultimately , reduced morbidity and mortality (Figure 2). The updated objectives focus on intramural activities (objective 1) and technology transfer to state and local health departments and internationally (objective 2) that will result in an improved public health infrastructure to combat infectious disease threats.
| Figure 2: Model for Prevention and Control
of Infectious Disease
|
Although ultimately the goal for infectious diseases is reduced morbidity and mortality, before this can occur, our nation's public health infrastructure must be rebuilt before we will see reductions in disease. For many infectious disease programs, including CDC's food safety activities, improvements in our ability to recognize and track these diseases and improved "early warning" surveillance systems will result in an increase in the number of reported cases and outbreaks before there is a downward trend resulting from effective prevention programs. As the capacity for surveillance and response becomes established, such as it is for Group B streptococcus, measures of success will be reflected by reductions in the number of cases.
Performance Goals and Measures
Performance Goal: Develop and strengthen epidemiologic and laboratory methods for detecting, controlling, and preventing infectious diseases.
Performance Measures:
| FY Baseline | FY 1999 Appropriated | FY 2000 Estimate |
| Assays are not currently available for public health use (FY 1998). | Assays to detect HIV mutations that are resistant to commonly used therapeutic agents will be developed and optimized. | |
| Assays are not currently being applied in public health settings. (FY 1998). | Assays for assessment of the duration, severity, and prognosis of HIV infection will be developed, optimized, and evaluated. | |
| 0 state/local health departments provided with support for Hepatitis C Virus (HCV) counseling, testing and referral demonstration sites (FY 1998). | 9 State/local health departments provided with support for HCV counseling, testing, and referral demonstration sites. | |
| 0 sentinel surveillance systems for acute and chronic Hepatitis C Virus (FY 1998). | Sentinel surveillance system for acute and chronic HCV will be developed and pilot tested. | Sentinel surveillance system for acute and chronic HCV will be established in select sites. |
| 15 large or unusual outbreaks of diarrheal and/or foodborne illness will be detected and investigated. (FY 1997). | 23 large or unusual outbreaks of diarrheal and/or foodborne illness will be detected and investigated. | 24 large or unusual outbreaks of diarrheal and/or foodborne illness will be detected and investigated. |
| 40% of reported foodborne outbreaks with identified toxin or causative organism (FY 1998). | The proportion of reported foodborne outbreak investigations in which the causative organism or toxin is identified will be increased to 45%. | The proportion of reported foodborne outbreak investigations in which the causative organism or toxin is identified will be maintained at 50%. |
| FY Baseline | FY 1999 Appropriation | FY 2000 Estimate |
| The proportion of reported foodborne outbreak in which the food that caused the outbreak is identified is 45% (FY 1998). | The proportion of reported foodborne outbreaks in which the food that caused the outbreak is identified will be increased to 50%. | The proportion of reported foodborne outbreaks in which the food that caused the outbreak is identified will be greater than 50%. |
| 3 extramural surveillance networks (1997). | 4 extramural domestic and global surveillance networks will monitor conditions including antimicrobial resistance, threats from transfusion of blood and blood products; infectious diseases among travelers and immunosuppressed and under-served populations. | 5 extramural domestic and global surveillance networks will monitor conditions including antimicrobial resistance, threats from transfusion of blood and blood products; infectious diseases among travelers and immunosuppressed and under-served populations. |
| Baselines are being collected. | Develop baseline data to better estimate the number of occupationally acquired blood borne infections (i.e., hepatitis B virus, HCV, HIV, varicella, and TB). | |
| 17 extramural awards will be provided to conduct enhanced research investigation to assist in development and improvement of diagnostic tests (FY 1997). | 22 extramural awards will be provided to conduct enhanced research investigations to assist in development and improvement of diagnostic tests for use in areas such as antimicrobial resistance, sexually transmitted diseases, malaria, Lyme disease, health-care associated infections, and blood safety. | 22 extramural awards will continue to be provided to conduct enhanced research investigations to assist in development and improvement of diagnostic tests for use in areas such as antimicrobial resistance, sexually transmitted diseases, malaria, Lyme disease, health-care associated infections, and blood safety. |
Performance Goal: Strengthen domestic and global epidemiologic and laboratory capacity for surveillance and response to infectious disease and bioterrorist threats.
Performance Measures:
| FY Baseline | FY 1999 Appropriated | FY 2000 Estimate |
| 0 States electronically linked (1998) | 6 State health departments will be electronically linked with CDC to provide TB results from overseas screening and U.S. follow-up assessments of both immigrants and refugees. | |
| 30 States supported (FY 1998). | 33 States will have increased epidemiologic and laboratory capacity for surveillance and response. | 43 states will have increased epidemiologic and laboratory capacity for surveillance and response. |
| Within 24 hours urgent results reported
(FY 1997). Within 2 weeks routine requests reported (FY 1997). |
The time for providing parasitic diseases reference laboratory diagnostic results to state laboratories will be improved in urgent situations, from 24 hours to 2 hours, and in routine cases, from 2 weeks to 2 days, in 90% of the requests. | Reduced time for providing reference laboratory diagnostic results in 90% of requests received will be maintained as 5 additional state/local laboratories are added to DPDx, CDC's Website for the diagnosis of parasitic diseases. |
| 10 states provided training in Calicivirus, Bartonella, and Ehrlichia diagnostics (1999) | Training will be provided to at least 18 states in Calicivirus, Bartonella, and Ehrlichia diagnostics. | |
| 13 Fellows trained (1997) | 40 Public Health Fellows will be trained and available for employment in local, state, and federal public health laboratories. | 70 Public health microbiology fellows will be trained and available for employment in local, state and federal public health laboratories. |
| 0% Countries with antimalArial drug resistance surveillance system (FY 1999). | Consistent with the Multilateral Initiative on Malaria, and in collaboration with WHO and participating countries, a surveillance system will be established to collect data on antimalArial drug resistance in 50% of sub-Saharan African countries. | |
| 10% participation by federally supported U.S. hemophilia treatment centers (1999). | Participation by federally supported U.S. hemophilia treatment centers (HCTs) in CDC's newly implemented Universal Data Collection (UDC) system, which is designed to monitor the safety of blood products and to track the health of persons with bleeding disorders, will be 60%. | |
| 2 countries with surveillance of unusual HIV variants (1999). | Surveillance for unusual HIV variants will be expanded from the current two countries to an additional six countries. | |
| 7 Emerging Infections Programs conducted early warning investigations (FY 1997). | 9 regional population-based Emerging Infections Programs will conduct early warning investigations of agents of infectious diseases. | 10 regional population-based Emerging Infections Programs will conduct early warning investigations of agents of infectious diseases. |
| 0 enhanced surveillance for influenza in 45 state and local health departments. | Enhanced surveillance for influenza will be initiated in 45 state and local departments. | |
| 0 states with enhanced foodborne surveillance and control activities for E. coli 0157:H7 (FY 1997). | Enhanced basic foodborne disease surveillance and control activities, for E. coli 0157:H7, will be available in 29 states and will be expanded to include Salmonella Typhimurium in 7 states. | Establish and enhance 8 active FoodNet foodborne surveillance sites. Expand state health department capacity to subtype and rapidly exchange information using PulseNet for E. coli (currently 29 Labs) and Salmonella Typhimirium (currently 7 labs) to 40 labs for each. |
| 0 state/local health departments and hospitals provided support for surveillance, prevention, and control of antimicrobial resistance (FY 1998). | 15 state/local health departments and hospitals provided support for surveillance, prevention and control of antimicrobial resistance. | |
| 17 Health Care Facilities conducted surveillance of occupation exposures and infections (FY 1998). | The number of health care facilities that conduct surveillance of occupation exposures and infections using the national Surveillance System for Health Care Workers (NaSH) will be increased to 50. | The number of health care facilities that conduct surveillance of occupation exposures and infections using the national Surveillance System for Health Care Workers (NaSH) will be increased to 100. |
| 0 Laboratory-based surveillance for Helicobacter pylori. | Laboratory -based surveillance for Helicobacter pylori will be established at three Alaska Native regional hospitals. | Laboratory -based surveillance for Helicobacter pylori will be maintained at three Alaska Native regional hospitals. |
| The baseline incidence of | The incidence of perinatal | The incidence of perinatal Group B streptococcal infections |
| 150 Daily dose per 1000 patient days (FY 1998). | The rate of inappropriate antimicrobial use will be reduced to < 100 daily doses per 1000 patient days as measured through the National Nosocomial Infections Surveillance (NNIS) System. | |
| The scope of the active surveillance network for foodborne diseases (FoodNet) is 7 sites (FY 1997). | The scope of the active surveillance network for foodborne diseases (FoodNet) will be expanded to 8. | The scope of the active surveillance network for foodborne diseases (FoodNet) will be maintained at 8. |
| 0 national state-based laboratory network for detection of bioterrorist agents (FY 1998). | Establish a national state-based laboratory network for detection of bioterrorist agents. | |
| 0 Training/technology transfer programs for state-of-art diagnostics for use in bioterrorism (FY 1998). | 10 Training/technology transfer programs for state-of-art diagnostics for use in bioterrorism. | |
| Increase the number of state and local health departments that have integrated various electronic surveillance systems and have electronic linkages to the medical community. These electronic systems include: Emerging Infectious Diseases , food safety, and bioterrorism surveillance systems, as well as the National Electronic Telecommunications System for Surveillance, the Sexually Transmitted Diseases Management Information System, and the HIV/AIDS surveillance systems. | ||
| Program Activity Funding | $137,636 | $181,926 |
Verification/Validation of Performance Measures: Successful accomplishment of these objectives will, in part, be verified using data submitted from funded states. Performance, in these instances, will be verified through on-site technical assistance and periodic visits and progress reviews. Other data are monitored using published and unpublished studies and recommendations.
Links to DHHS Strategic Plan
These performance measures are related to the DHHS Goal 1: To
promote health and reduce major threats to health and productive lives for all
Americans; DHHS Goal 5: Improve public health and safety systems; and DHHS Goal
6: Strengthen the Nation's science base for health and human services. To
accomplish these objectives, CDC collaborates with a number of agencies and
organizations including: Council of State and Territorial Epidemiologists,
Association of State and Territorial Public Health Laboratory Directors,
National Institutes of Health, Food and Drug Administration, Department of
Agriculture, Department of Interior (U.S. Fish and Wildlife), Department of
Justice (U.S. Immigrations and Naturalization Service), Department of State,
Department of Treasury (U.S. Customs), and the GeoSentinel project.
Tuberculosis
Tuberculosis (TB) is an example of an infectious disease that did undergo a sustained decades-long decline until the mid 1980s only to reemerge strongly in the late 1980s and early 1990s with drug-resistant strains. In 1989, the Secretary of the Department of Health and Human Services stated the goal of eliminating TB: "It is time to commit to a tuberculosis-free society." But a resurgence was associated with a deterioration of the public health infrastructure and complicated by the AIDS epidemic, increased numbers of cases among the foreign born, and transmission of tuberculosis in institutions, particularly in hospitals and prisons. During the 1970s and 1980s, many health departments around the country redirected TB control funds to other activities; key elements of some TB control programs were dismantled. Progress toward the control of TB slowed in the years 1985 to 1992 when the downward TB trend reversed, TB cases increased by 20 percent, and outbreaks of multidrug-resistant tuberculosis (MDR-TB) and deaths among health care workers occurred. In 1992-1993, additional resources helped to rebuild the crumbling public health TB infrastructure permitting health departments to address these problems, and TB declined again from 1993-1998. Achievement of this long term strategic objective requires a continued commitment of resources to prevent additional deterioration of the necessary infrastructure at the local, state, and/or federal levels. Reducing the case rate of tuberculosis will put the Nation back on track toward eliminating TB from the U.S.
Performance Goals and Measures
Performance Goals:
Reduce the tuberculosis case rate through the following strategies:
Performance Measures:
| FY Baseline | FY 1999 Appropriated | FY 2000 Estimate |
| 66.8% (1993) (FY 1999 data will be available mid- 2001). |
At least 85% of TB patients will complete
a course of curative TB treatment within 12 months of initiation of
treatment (some patients require more than 12 months treatment).
|
At least 85% of TB patients will complete a course of curative TB treatment within 12 months of initiation of treatment (some patients require more than 12 months treatment). |
| 87.4% (1994). (FY 1999 Data available mid-2000). |
At least 92% of TB patients with initial positive cultures will also have drug susceptibility results. | At least 92% of TB patients with initial positive cultures will also have drug susceptibility results. |
| 68.4 % (1993) (FY 1999 Data available late 2001). |
At least 75% of contacts of infectious cases and | At least 75% of contacts of infectious cases and |
| 64.8% (1993). (FY 1999 Data available late 2001). |
70% of other high risk infected persons who are placed on preventive therapy will complete a regimen. | 70% of other high risk infected persons who are placed on preventive therapy will complete a regimen. |
| Priority Variables have been
selected and the 1993 baselines for complete reporting of these variables
are: DOB (99.9%); Country of origin (99.3%); Sex (100.0%); Race (99.8%); Month-year arrived in U.S. (71.8%); Status at diagnosis of TB (99.7%); Major site of disease (99.9%); AFB Smear (99.3%); AFB Culture (99.7%); TB skin test (83.4%); Initial drug regimen (99.9%); Initial drug susceptibility results (96.1%);Previous TB (99.2%); Year of diagnosis (93.3%); HIV status-all ages (27.5%); HIV status-ages 25-44 (41.4%); Resident of correctional facility (95.4%) and long term facility (82.8%); Sputum conversion (90.4%); Reason stopped therapy (99.8%); DOT used/not used (97.9%); Date therapy stopped (99.6%). (Note: the percentages reported are the percent with complete reporting results for each variable.) Data are collected electronically as part of the national TB surveillance system. (FY 1999 Data available mid-2000). |
States will report information to CDC on identified priority variables. | States will report information to CDC on identified priority variables. |
| Total FY Funding | $119,962 | $119,962 |
Verification/Validation of Performance Measures: All confirmed cases of TB are regularly listed in the Report of Verified Case of Tuberculosis (RVCT) and follow-up information is submitted electronically to CDC via Tuberculosis Information Management System software. Verification of performance will be conducted through a review of data collected by these two systems. Additionally for the third measure listed above, state and metropolitan area health departments will assist with performance verification.
Links to DHHS Strategic Plan
These performance measures relate to DHHS Goal 1: Reduce
major threats to the health and productivity of all Americans. In addition to
state and major city health departments, the Division of Tuberculosis
Elimination also works with the Advisory Committee for the Elimination of TB,
the National TB Controllers Association, and the American Lung
Association/American Thoracic Society to set guidelines, recommendations, and
policies related to TB prevention and control.
HIV/AIDS
The epidemic of HIV and AIDS presents unique social, economic, and public health challenges to governments and individuals in the United States and around the world. Although significant progress has been made in understanding the disease and developing both prevention strategies and treatments since the first case was reported in the U.S. in 1981, HIV remains a deadly infection for which there is no vaccine or cure and for which there are limited treatments. An average of 100 Americans are diagnosed with AIDS every day, and approximately 100 men, women, and children become infected with HIV every 24 hours. Globally, 16,000 people become infected each day, including nearly 1,000 children.
Through June 1998, a total of 655,357 cases of AIDS among persons in the U.S. had been reported to CDC, and more than 401,000 of these persons have died. Since 1987, AIDS has risen from being the 15th leading cause of death among all Americans to the 8th. AIDS is now a leading cause of death among Americans aged 25 to 44. CDC estimates that approximately 40,000 Americans are becoming newly infected with HIV each year and that between 650,00 and 900,000 Americans are currently living with HIV.
Transmission of HIV infection can be prevented through changes in high-risk behaviors. Prevention is an important cost-effective component of the control of HIV infection. Disadvantaged populations, especially African-Americans and socio-economically stressed youth, continue to have high rates of HIV infection despite high levels of knowledge about behavioral prevention methods. Two biomedical interventions have demonstrated possibilities in reducing the spread of this deadly disease. First, antiretroviral combination therapy lowers viral load, which may translate to lower infectivity and, second, there is some evidence that treatment of other STDs can reduce the spread of heterosexually transmitted HIV infection.
CDC will increase the urgent prevention needs in ethnic and racial minority communities using funding increases received in FY 1999. This increase augments existing prevention efforts addressing disparities in health among ethnic and racial minorities. These activities include:
Successful prevention of HIV transmission requires individual effort as well as the collective participation of federal, state, and local governmental, non-governmental, and international organizations. The federal government's role is critical in providing assistance to state and local health agencies and community-based organizations to implement effective HIV risk reduction and prevention programs, surveillance of the incidence of HIV and AIDS, research, evaluation, training, and technology transfer of effective interventions, prevention programs, and evaluation activities.
The following are external factors that affect accomplishing goals and objectives for the HIV program:
Additionally, in the case of counseling and testing, it should be noted that in formulating the performance measure for this area, a number of complex factors were considered in estimating the improvement in the overall rate of persons who return for their HIV tests. The objective addressing this issue is based upon an annual evaluation of over 2.6 million HIV tests, reported from nearly 10,000 sites. The proposed 10% increase over the next two year period is viewed as a challenging, though attainable figure. The figure is not conservative, especially in view of the fact that these figures represent a relatively small percentage (perhaps 10%) of the total number of HIV tests performed in the United States each year, and that performance varies considerably by test site category. As an example, hospitals and private physicians report the lowest levels of HIV-positive patients returning (44%) and there are relatively few incentives that CDC and its partners can use to improve their rates. By contrast, CDC-supported facilities, such as free-standing counseling and testing sites and family planning sites report a return rate of over 81%. Other factors, such as improvements in testing technologies may make "results while you wait" a possibility in some settings, and will also compromise the value of retaining this as a performance objective for more than the next few years.
Every school day, 50 million young people attend over 110,000 schools across the nation. Research has demonstrated that HIV education in schools can be effective in reducing risk behaviors among youth. CDC's efforts to help State and local education agencies implement HIV prevention education programs in schools nationwide include teacher training programs, dissemination of model policies and effective prevention programs, evaluation and technical assistance. The performance measures for this aspect of CDC's HIV/AIDS prevention program monitor students' exposure to HIV/AIDS prevention education in schools and youth behaviors that affect their risk of becoming infected with HIV. The selected measures are derived from epidemiologic modeling that describes the connections and inter-relationships of policies and programs; knowledge, attitudes, and skills; health behaviors; and health outcomes.
Performance Goals and Measures
Performance Goal: Improve the ability of the Nation's HIV/AIDS surveillance system to identify incidence and prevalence of HIV infection.
Performance Measures:
| FY Baseline | FY 1999 Appropriated | FY 2000 Estimate |
| N/A | CDC's current guidelines for security and confidentiality contained in the HIV/AIDS surveillance guidelines are updated to include minimum standards of performance for state and local and HIV/AIDS surveillance programs. | 100% of states will begin to adopt recommended confidentiality standards. |
| Baselines will be established. | Baselines will be established for measuring incidence in selected high-risk populations. | Baselines will be established for measuring incidence in selected high-risk populations. |
| N/A | CDC will provide technical assistance to all states to help them develop reliable minimal estimates for HIV prevalence. | |
| N/A | Trends in long-term survival and rates of transmission of new infections will be measured. | Trends in long-term survival and rates of transmission of new infections will be measured. |
Performance Goal: Reduce the rate of heterosexually acquired AIDS cases, as well as AIDS cases related to injecting drug use and male homosexual contact, through the implementation of HIV prevention programs as part of a community planning process. Reduce the rate of perinatally-acquired AIDS cases.
Performance Measures:
| FY Baseline | FY 1999 Appropriated | FY 2000 Estimate |
| 11,500 cases 1,2 (1997).
(Data for HIV FY 1999 measures will be available around May 2000). |
The number of heterosexually-acquired AIDS cases will be decreased by 10% from the 1995 base of 9,300 AIDS cases diagnosed. | The number of heterosexually-acquired AIDS cases will be decreased by 10% from the 1997 base of 11,500 AIDS cases diagnosed. |
| 15,700 cases
1,2 (1997).
(Data for HIV FY 1999 measures will be available around May 2000). |
The number of AIDS cases related to injecting drug use will be decreased by 15% from the 1995 base of 17,800 cases diagnosed. | The number of AIDS cases related to injecting drug use will be decreased by 10% from the 1997 base of 15,700 cases diagnosed. |
| FY Baseline | FY 1999 Appropriated | FY 2000 Estimate |
| 21,300 cases 1,2 (1997).
(Data for HIV FY 1999 measures will be available around May 2000) |
The number of AIDS cases related to male homosexual contact will be decreased by 20% from the 1995 base of 28,600 cases diagnosed. | The number of AIDS cases related to male homosexual contact will be decreased by 10% from the 1997 base of 21,300 cases diagnosed. |
| 299 cases 3 (1997).
(Data for HIV FY 1999 measures will be available around May 2000). |
The number of perinatally-acquired HIV/AIDS cases will be decreased by 50% from the 1993 base of 8654 cases diagnosed. | The number of perinatally-acquired HIV/AIDS cases will be decreased by 10% from the 1997 base of 2993 reported cases. |
1 Numbers represent diagnosed cases adjusted for
reporting delay with risk redistributed.
2 Change in baseline data from 1995 (in FY 1999) to
1997 (in FY 2000) reflects adjustments in AIDS case definitions, and
availability of more accurate data.
3 These numbers do not represent actual cases of
children diagnosed with AIDS. Rather, these numbers are point estimates based on
cases diagnosed using the 1987 definition, adjusted for reporting delays.
4 Represents number adjusted for reporting delay of
diagnosed perinatal AIDS cases for 1993.
Performance Goal: Among persons counseled and tested for HIV infection in CDC-supported sites, improve the percentage of persons who return for their results and post-test counseling.
Performance Measure:
| FY Baseline | FY 1999 Appropriated | FY 2000 Estimate |
| 61% (1996). | Increase the percentage of persons who return for their results and posttest counseling from 61% in 1996 to 67% in 1999 (10% relative increase). | Increase the percentage of persons who return for their results and posttest counseling from 61% in 1996 to 67% in 2000 (10% relative increase). |
Performance Goal: Reduce the percentage of HIV/AIDS-related risk behaviors among school-aged youth through dissemination of HIV prevention education programs.
Performance Measure:
| FY Baseline | FY 1999 Appropriated | FY 2000 Estimate |
| YRBS Baseline : 86% (1995). | Achieve and maintain the percentage of high school students who have been taught about HIV/AIDS prevention in school at 90% or greater. | Achieve and maintain the percentage of high school students who have been taught about HIV/AIDS prevention in school at 90% or greater. |
| YRBS Baseline: 53% (1995). | Reduce the percentage of high school students who have ever engaged in sexual intercourse by 15% (to 45%). | |
| FY Baseline | FY 1999 Appropriated | FY 2000 Estimate |
| YRBS Baseline: 46% (1995). | Reduce the percentage of currently sexually active high school students who engage in sexual intercourse without a condom by 15% (to 39%). |
Verification/Validation of Performance Measures: The number of AIDS cases reported will be monitored using the National HIV/AIDS Reporting System. The system is routinely evaluated for data quality and has very high rates of reporting completeness and timeliness. Data for this performance measure are collected on a biennial basis (during odd-numbered years) through CDC's Youth Risk Behavior Surveillance System (YRBSS), a system designed to focus attention on priority behaviors among youth that cause the most important health problems. YRBSS was developed in a partnership with numerous federal agencies, state departments of education, scientific experts, and survey research specialists. The YRBSS includes separate national, state and local school-based surveys of high school students. A recent study of the YRBSS provides evidence that this adolescent survey has good reliability in measuring health behavior.
Baseline data will be used from the 1995 YRBSS data collection because: (a) it was the most recent data available when the original measures were created and, consequently, has been used throughout the entire process to determine our targets for FY 1999 & FY 2000, and (b) the 1995 data will better allow us to illustrate trends in sexual behaviors over time.
Links to DHHS Strategic Plan
These objectives relate to DHHS Goal 1: Reduce major threats
to the health and productivity of all Americans. CDC continues to work closely
with the Health Resources and Services Administration and the National Academy
of Sciences to implement the language in the Ryan White legislation and to
evaluate the extent to which states' efforts have been effective in reducing
perinatal transmission of HIV. CDC is collaborating with the Substance Abuse and
Mental Health Services Administration and the National Institute for Drug Abuse
on issues related to transmission of HIV/AIDS in the injecting drug using
population. A working group has also been established to address health care
issues in correctional institutions.
Performance Goal: Increase the capacity of community-based organizations providing HIV prevention services to persons of color.
Performance Measures:
| FY Baseline | FY 1999 Appropriated | FY 2000 Estimate |
| 94 directly funded organizations. | N/A | Fund 30 community-based organizations to provide priority HIV prevention services to HIV-infected persons. |
| 94 directly funded organizations. | N/A | Fund 20 community development grants to expand community demonstration projects. |
| Total Program Funding | $657,000 | $666,500 |
Verification/Validation of Performance Measures: By the end of FY 1999, a RFA will be developed and selected community based organizations will be funded. In FY 2000, grantees will report on the development progress and evaluation plans which will be reviewed by CDC staff.
Links to DHHS Strategic Plan
These performance objectives are related to DHHS Goals 1:
Reduce major threats to the health and productivity of all Americans.
Development and implementation of the plan to Eliminate Ethnic Health
Disparities is an inter-agency effort within DHHS.
Sexually Transmitted Diseases
Sexually Transmitted Diseases (STDs) are one of the most critical challenges in the nation today because of their severe, costly consequences for women and infants; their tremendous impact on the health of adolescents and young adults (especially among minority populations); and the integral role they play in the transmission of HIV infection. CDC recently reported that over 85% of the most common infectious diseases in the U.S. are sexually transmitted. The immediate and long-term disease burden and costs associated with STDs globally and in the U.S. are immense. Conversely, an investment in STD prevention is leveraged several ways--it improves the health of women, infants, and young people, and slows down the spread of HIV infection in our most vulnerable and disadvantaged populations. In addition to the human costs, STDs other than AIDS add 10 billion dollars to the nation's health care costs each year.
The U.S. has one of the highest STD rates in the industrialized world. U.S. rates of gonorrhea are 50 to 100 times higher than rates in Sweden. Canada and some Western European countries have nearly eliminated infectious syphilis. In the U.S., large-scale regional screening demonstration programs have rapidly, dramatically, and reproducibly reduced chlamydia prevalence in women. Chlamydia, a serious reproductive tract infection with many associated negative health consequences, is currently the most frequently reported infectious disease in the U.S. Estimates are that 4 million new cases occur annually, as many as one-half occurring among women ages 15-19. Chlamydia often causes severe medical conditions that are also costly, especially in women (pelvic inflammatory disease, ectopic pregnancy, and infertility) and in newborns (eye infections and pneumonia). Conservatively, these reproductive consequences in women result in an estimated annual cost of chlamydia infection in the U.S. of $1.5 billion, $1.1 billion of which is attributed to treatment of preventable, serious after-effects in women. In recent years, a number of effective biomedical interventions that prevent these consequences and save money have been implemented in some parts of the country. To date, however, most women in need of these interventions are not being served.
Although STD prevention is technically feasible today in the U.S., an effective national system for STD prevention currently does not exist. Among the obstacles to establishing such a system are: (1) profound cultural and social barriers to adoption of healthy sexual behaviors; (2) a fragmented system of informational and educational services that leads to inadequate awareness of STDs and misperceptions of risk among high risk individuals; (3) a fragmented system of STD-related clinical services manifested by inadequate training of health care providers, the under-recognition of the importance of private sector providers in STD prevention, and the absence of innovative services targeted to youth and disenfranchised populations that lead to inadequate diagnosis and treatment of STDs or missed clinical opportunities; (4) inadequate integration and coordination of STD, HIV, unintended pregnancy, and cancer prevention programs at the local level despite the STRONGinterrelationships among these conditions; and (5) inadequate human and financial resources in both the public and private sectors to meet recognized needs for behavioral and biomedical solutions.
Performance Goals and Measures
Performance Goal: Reduce STD rates by providing chlamydia and gonorrhea screening, treatment, and partner treatment to 50% of women in publicly funded family planning and STD clinics nationally.
Performance Measures:
| FY Baseline | FY 1999 Appropriated | FY 2000 Estimate |
| 11.6% (1995)
(FY 1999 Data available May/June 2000). |
The prevalence of Chlamydia trachomatis among high risk women under 25 will be reduced from 11.6% (1995) to less than 8%. | The prevalence of Chlamydia trachomatis among high risk women under 25 will be reduced from 11.6% (1995) to less than 8%. |
| 9% (1996)
(FY 1999 Data available May/June 2000). |
The prevalence of Chlamydia trachomatis among women under the age of 25 in publicly funded family planning clinics will be reduced from 9% (1996) to less than 6%. | The prevalence of Chlamydia trachomatis among women under the age of 25 in publicly funded family planning clinics will be reduced from 9% (1996) to less than 6%. |
| 300 per 100,000 (1995).
(FY 1999 Data available May/June 2000). |
The incidence for gonorrhea in women aged 15-44 will be reduced from 300 per 100,000 (1995) to less than 250 per 100,000.1 | The incidence for gonorrhea in women aged 15-44 will be reduced from 300 per 100,000 (1995) to less than 235 per 100,000.1 |
| 162 per 100,000 (1995). (FY 1999 Data available 2002). |
The incidence of PID, as measured by a reduction in hospitalizations for PID, will be reduced from 162 per 100,000 (1995) to less than 125 per 100,000 women aged 15-44, and | The incidence of PID, as measured by a reduction in hospitalizations for PID, will be reduced from 162 per 100,000 (1995) to less than 125 per 100,000 women aged 15-44, and |
| 245,000 (1995). (FY 1999 Data available 2002). |
the number of initial visits to physicians for PID will be reduced from 245,000 (1995) to less than 225,000. | the number of initial visits to physicians for PID will be reduced from 245,000 (1995) to less than 225,000. |
1 The measure was changed from 200 per 100,000 to
250 per 100,000 (FY 1999) based on a slowing in the rate of decrease in
gonorrhea since the base year (1995). The focus of the STD program over the next
several years will be syphilis elimination rather than gonorrhea, with the
primary gonorrhea prevention effort devoted to identification and treatment of
females through screening to prevent the complications of gonorrhea.
Performance Goal:
Reduce the incidence of congenital syphilis through the following strategies:
Performance Measure:
| FY Baseline | FY 1999 Appropriated | FY 2000 Estimate |
| 47.4 per 100,000 (1995).1
(FY 1999 Data available May/June 2000). |
The incidence of congenital syphilis in the general population will be reduced from 39 per 100,000 live births (1995) to less than 20 per 100,000 live births.2 | The incidence of congenital syphilis in the general population will be reduced from 39 per 100,000 live births (1995) to less than 20 per 100,000 live births. |
1 Changes in baseline
data from 39 per 100,000 to 47.4 per 100,000 was due to a correction in data
received from STD data collection system.
2 Because of the
drastic decrease in adult infectious syphilis, the previous 1999 goal of 30 per
100,000 live births was exceeded in 1998 (24.6 per 100,000 live births).
Performance Goal: Reduce the incidence of primary and secondary syphilis through the development of syphilis elimination action plans for each state that had a primary and secondary syphilis rate in 1995 of greater than or equal to 4 per 100,000 population and an HIV prevalence in childbearing women of greater than 1 per 1,000.
Performance Measure:
| FY Baseline | FY 1999 Appropriated | FY 2000 Estimate |
| 81% (1995). | At least 85% of U.S. counties will have an incidence of primary and secondary syphilis in the general population of less than or equal to 4 per 100,000. This is an increase from 81% in 1995. | At least 85% of U.S. counties will have an incidence of primary and secondary syphilis in the general population of less than or equal to 4 per 100,000. This is an increase from 81% in 1995. |
| Total Program Funding | $123,753 | $130,649 |
Verification/Validation of Performance Measures: Data will be collected through the National STD Surveillance System. Data will be verified through the National Comprehensive STD Prevention System and the National Infertility Prevention Program.
Links to DHHS Strategic Plan
These performance measures relate to DHHS Goal 1: Reduce
major threats to the health and productivity of all Americans.
V. Immunization
Appropriate administration of safe and effective vaccines remains the most cost-effective method of preventing disease, disability, and death and reducing economic costs resulting from vaccine-preventable diseases. For every dollar spent on measles-mumps-rubella (MMR) vaccination, $13 is saved.
Beginning in 1962 when it proposed the first national effort to improve the immunization status of children, CDC has counted immunization among its most vital programs, recognizing it as a core public health activity and perhaps the best example of effective primary prevention. CDC's National Immunization Program (NIP) focuses on several major programmatic areas to achieve its goals, including childhood immunization, adult immunization, and global polio eradication. Although NIP has assistance from many partners, state and local health agencies play a primary role in helping NIP carry out its mission in the United States. State and local health agencies use CDC grant funds for a wide range of activities including hiring staff, conducting surveillance, assessing immunization levels, developing immunization registries, conducting education and outreach, and establishing partnerships with community groups and private sector organizations.
Disease eradication and elimination programs are a shared effort. NIP collaborates with the World Health Organization, Rotary International, the United States Agency for International Development, the Task Force for Child Survival and Development, UNICEF, other centers within CDC, and international agencies, to enhance polio eradication efforts by providing scientific assistance and financial support for vaccine purchase and other key activities. This collaboration is unique among public health initiatives for the unprecedented level of partnerships. Extraordinary progress towards eradicating polio worldwide by the year 2000 continues to occur, suggesting that the current global strategies are effective and that achievement of the global objective is feasible. Examples of activities include:
There are two primary sources to measure attainment of performance goals. The National Notifiable Diseases Surveillance System (NNDSS) is the data source for tracking cases of vaccine-preventable disease. Provisional data from this system are routinely published in the Morbidity and Mortality Weekly Report (MMWR). Final data are published in the Annual Summary of Notifiable Diseases.
CDC collects vaccination coverage data at the national, state, and local levels through the National Immunization Survey (NIS). With these data, the impact of national, state, and local policies and programs can be evaluated and monitored, and the results will provide the primary means of monitoring progress toward the goals of the performance plan. These surveys measure antigen-specific and series complete coverage by selected age categories, with detailed analyses for race/ethnicity and by poverty groups also being presented. Such surveys are necessary to monitor the improvement of immunization coverage levels in the target populations of 78 state and local areas.
Although coverage for preschool immunization is high in almost all states, pockets of need, or areas within each state and major city where substantial numbers of under-immunized children reside, continue to exist. These areas are of great concern because, particulary in large urban areas with traditionally under-served populations, there is a potential for outbreaks of vaccine-preventable diseases.
Infrastructure funds are essential to sustain the systems that have resulted in the highest immunization levels ever recorded at or near record low levels of disease incidence. These funds are used to implement proven strategies to raise immunization coverage, to conduct vaccine-preventable disease surveillance, to implement disease outbreak control measures, to assure adequate access to and appropriate administration of vaccines, to perform outreach activities, to develop immunization registry systems, to educate providers and parents about the need for timely immunization, and to assess immunization coverage levels and pockets of under-immunized children, among many other activities. Infrastructure investments must be maintained to ensure that proven systems and high immunization levels are not jeopardized.
Performance Goals and Measures
Performance Goal: Reduce the number of cases of vaccine-preventable diseases.
Performance Measures:
| FY Baseline | FY 1999 Appropriated | FY 2000 Estimate |
| Vaccine Preventable Diseases (Indigenous Cases Only) Paralytic polio 0 (1997). Rubella 161 (1997). Measles 138 (1997). Haemophilus influenzae 165 (1997). Diphtheria 5 (1997). Congenital rubella syndrome 4 (1997). Tetanus 43 (1997) . |
The number of cases of paralytic polio, rubella, measles, Haemophilus influenzae invasive disease in children under 5 years, diphtheria, congenital rubella syndrome, and tetanus will remain at or be reduced to 0. | The number of cases of paralytic polio, rubella, measles, Haemophilus influenzae invasive disease in children under 5 years, diphtheria, congenital rubella syndrome, and tetanus will remain at or be reduced to 0. |
| Mumps 612 (1997). | The number of cases of mumps will be reduced from 612 (1997) to 500. | The number of cases of mumps will be reduced from 612 (1997) to 500. |
| Pertussis 5,519 (1997) | The number of cases of pertussis will be reduced from 5,519 (1997) to 2,000. | The number of cases of pertussis will be reduced from 5,519 (1997) to 2,000. |
Performance Goal: Ensure that 2-year-olds are appropriately vaccinated.
Performance Measures:
| FY Baseline | FY 1999 Appropriated | FY 2000 Estimate |
90% vaccination coverage for each vaccine
(1997).
|
Achieve or sustain immunization coverage
of at least 90% among children 2 years of age for each vaccine:
|
At minimum, achieve or sustain the
following immunization coverage of at least 90% among children 2 years of
age for each vaccine:
|
Performance Goal: Increase pneumococcal pneumonia and influenza vaccination among persons 65 years.
Performance Measure:
| FY Baseline | FY 1999 Appropriated | FY 2000 Estimate |
| Influenza: 58% (1995). | The rate of vaccination among non-institutionalized high-risk populations will be increased to 60% for influenza and | The rate of vaccination among persons 65 years will be increased to 60% for influenza and |
| Pneumonia: 32% (1995). | to 54% for pneumococcal pneumonia. | to 60% for pneumococcal pneumonia. |
Verification/Validation of Performance Measures: These data will be validated as stated above in the program description with the addition of the National Health Interview Survey for pneumonia and influenza.
Links to DHHS Strategic Plan
These performance measures relate to DHHS Goal 5: Improve
public health systems. CDC collaborates with Health Resources and Services
Administration, the Health Care Financing Administration, the Food and Drug
Administration, the National Institutes of Health, and others in achieving these
objectives.
Performance Goal: Collaborate with domestic and international partners to help achieve WHO's goal of global polio eradication by December 31, 2000.
Performance Measures:
| FY Baseline | FY 1999 Appropriated | FY 2000 Estimate |
| 382 million (1998) | Increase the number of doses of oral polio vaccine purchased to assist in conducting mass immunization campaigns in Asia, Africa, and Europe to 445 million. | Increase the number of doses of oral polio vaccine purchased to assist in conducting mass immunization campaigns in Asia, Africa, and Europe to 526 million. |
| 60 (1998) | Expand the network of CDC and CDC-funded staff, epidemiologists, virologists, technical and scientific officers on long-term assignments in WHO country and regional offices to 67 persons. | Expand the network of CDC and CDC-funded staff, epidemiologists, virologists, technical and scientific officers on long-term assignments in WHO country and regional offices to 82 persons. |
| 0 (1998) | Expand a special program to prepare a cadre of 50 trained public health professionals throughout CDC to complete short-term assignments with WHO. | Expand a special program to prepare a cadre of 60 trained public health professionals throughout CDC to complete short-term assignments with WHO. |
| Total Program Funding | $449,477 | $526,167 |
VI. Health Statistics
CDC's National Center for Health Statistics provides STRONGleadership in monitoring the health of the American people and is a vital, unique resource for health information. As the Nation's principal health statistics agency, NCHS provides statistical information to guide actions and policies to improve health of Americans. In the current climate of dramatic change in the health system, such data become critically important and play a crucial role in public health and health policy. Unprecedented changes make investments in determining health status and monitoring health system structure, operation, quality, and effectiveness a clear priority. There is significant demand, as well as new opportunities, for using new approaches to monitoring, assessing, and evaluating key public health, health policy, and welfare policy changes. CDC is taking significant steps to improve the speed with which data are made available to researchers, policy makers, and the public. The National Vital Statistics System has greatly improved the timeliness of data which are highly relevant to health and welfare reform monitoring, through the introduction of a "preliminary" data set in 1996. Preliminary data, though less detailed, were released a full year ahead of the final data, affording policy makers an early view of major trends in births and deaths. Similarly, data from the most recent National Health and Nutrition Examination Survey (NHANES) were released on a timetable that was nearly two years earlier than previous survey cycles. Continuing efforts to automate the collection of data, apply new data processing and analytic tools, and disseminate data more widely via the Internet will result in further improvements in timeliness and access.
NCHS represents an investment in broad-based, fundamental public health and health policy statistics that meets the needs of a wide range of users. This investment has important payoffs in:
Because these data are widely used to track current issues and make decisions, it is crucial that these data are as current and accessible as possible. The more current the data, the more likely it is that policy makers will base their decisions on information that accurately reflects the most recent developments in health and health care.
NCHS continually strives to meet priority data needs by improving ongoing surveys, developing new tools for monitoring health, and finding new ways to make data accessible to users. Important steps underway include the beginning of full field operation of the National Health and Nutrition Examination Survey, which fills an important gap in our knowledge of health by taking direct measurements in mobile examination centers that move around the U.S. Other steps include the capability to conduct state-level monitoring surveys using the State and Local Area Integrated telephone Survey (SLAITS). Efforts to improve the usability of NCHS data include improving timeliness, increasing access through the Internet, and facilitating research based on detailed, micro-data without jeopardizing confidentiality of our respondents.
Performance Goals and Measures
Performance Goal: Better anticipate the future directions of the health care system and health behaviors in order to design effective public health policy by:
| FY Baseline | FY 1999 Appropriated | FY 2000 Estimate |
| 1. Baseline data used is the conduct of three major data systems in 1997. In 1999 a fourth (NHANES) major data system was returned to field operation. | 1. Conduct ongoing surveys and data systems that produce detailed trend data needed for monitoring health. | |
| 2. Baseline data in 1998, no new targeted data collection efforts are being made. | 2. The development of SLAITS, which includes conduct of a pretest in 3 test sites including one Indian Reservation, will be finalized. 1 | 2. Developing new monitoring tools needed to address emerging topics. With initiative funding in FY 2000, five targeted data collection efforts will be established to address emerging data needs. |
| 3. N/A | 3. The development of NHANES IV, including conduct of a pretest, will be finalized. 1 | 3. NHANES IV will have completed the first full year of data collection using newly automated survey, examination, and laboratory methods that will improve timeliness of data release. |
| 4.The baseline for this measure is 6 months in 1996. | 4.Monthly vital statistics reports will be available to be viewed, searched, and downloaded via the Internet within 4 months of data release. 1 | 4. Monthly vital statistics reports will be available to be viewed, searched, and downloaded via the Internet within 4 months of data release. |
| 5. N/A. | 5. Release statistics in new formats to speed the release of data on high-priority topics (e.g., Teenage Births in the United States: National and State Trends 1990-96). Release 1 report in such format. | |
| 6. Baseline data is during 1998, NCHS data center was established with no researchers with access. With the increase in resources, in FY 2000 approximately 40 researchers will access the NCHS secure data center. | 6. Establish an NCHS Data Center, which will allow non-NCHS researchers to access detailed data files in a secure environment, without jeopardizing the confidentiality of respondents. | |
| 7. Baseline data used is release of 1993 final mortality dat in 26 months which occurred in 1996 as published in Volume 44 no, 7: Supplement to the Monthly vital Statistics Report, dated February 29, 1996 "Advance Report of Final Mortality Statistics, 1993." Included in baseline data is the release of 1994 final natality data in 18 months which occurred in 1996 as published in Volume 44 no. 11: Supplement to the Monthly Vital Statistics Report, dated February 29, 1996 "Advance Report of Final Natality Statistics, 1994.". | 7. Time lag in release of final Vital Statistics will be reduced by 1 month. 1 | 7. With the increased funding, time lag in release of final Vital Statistics will be reduced by 2 months. Currently, data are released within 21 months following the end of the data collection year. |
| 8. Baseline data: In 1997 Health United States 1997 was published demonstrating various trends. | 8. Produce reports and publications that document trends, issues, and problems in health. | |
| Total Program Funding |
$94,573 |
$109,573 |
1 FY 1999 measures were changed to reflect the increased funding for Health Statistics and to better represent the program activities.
Verification/Validation of Performance Measures: The National Center for Health Statistics will maintain administrative documentation that verify performance of these objectives through contractor reports, pretest reports, proceedings from meetings of scientific partners, copies of publications, and records of ti
