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Sylvia Mathews BurwellSecretary
Department of Health and Human Services (HHS)
Mission
Overview
The Department of Health and Human Services (HHS) is the United States government's principal agency for protecting the health of all Americans and providing essential human services, especially for those who are least able to help themselves.
HHS represents almost a quarter of all federal outlays and administers more grant dollars than all other federal agencies combined. HHS’s Medicare program is the nation’s largest health insurer, handling more than 1 billion claims per year. Medicare and Medicaid together provide health care insurance for one in four Americans.
HHS works closely with state and local governments, and many HHS-funded services are provided at the local level by state or county agencies, or through private sector grantees. The Department supports more than 300 programs, covering a wide spectrum of activities administered by 11 operating divisions. In addition to delivering services, HHS programs support the collection of health data and provide for the equitable treatment in health care and human service settings. The Department’s activities include:
- Health, biomedical, and social science research;
- Health promotion and community-based health programs;
- Disease prevention, including immunization services;
- Assuring food and drug safety;
- Health insurance for Americans, including elderly and disabled Americans, individuals with pre-existing conditions, low-income people and others through Medicare, Medicaid, the Children's Health Insurance Program (CHIP), Health Insurance Exchanges, Pre-Existing Condition Insurance Plans and other programs;
- Health information technology;
- Public health infrastructure;
- Financial assistance and services for low-income families;
- Maternal and infant health programs;
- Early childhood development programs;
- Child abuse and domestic violence prevention;
- Substance abuse and mental health services;
- Services for older Americans, including home-delivered meals;
- Comprehensive health services for Native Americans; and
- Medical preparedness for emergencies, including potential terrorism.
With the passage of the Affordable Care Act, HHS has been moving forward to implement the law and help improve the health of millions of Americans. The law puts in place comprehensive reforms that protect Americans from the worst insurance company abuses, makes health insurance more affordable, provides better access to care and coverage, and strengthens Medicare.
For example, HHS is working with states to establish new transparent and competitive insurance marketplaces called Affordable Insurance Exchanges where, beginning in 2014, individuals and small businesses can compare their coverage options and buy affordable health coverage. Additionally, many important benefits and protections have already gone into effect, helping millions get the coverage they need and putting Americans back in charge of their health care. Because of the law:
- Young adults can stay on their parent’s plan until age 26,
- Health plans cannot limit or deny benefits or deny coverage for a child younger than age 19 because of a pre-existing condition,
- A health insurance policy cannot be canceled because of a simple mistake on an application, and lifetime dollar limits on most benefits are banned for all new health insurance plans, and
- New standards for medical loss ratio and rate review ensure consumers get value for their premium dollars and that proposed rate increases are based on reasonable cost assumptions and solid evidence.
Transforming the health care system, which includes implementing the Affordable Care Act, is a cornerstone of the HHS Strategic Plan. The current Strategic Plan outlines HHS’s main objectives and performance measures to monitor our progress. Additional metrics are available in the HHS Online Performance Appendix.
To ensure public access and transparency, HHS launched www.HealthCare.gov on July 1, 2010. The site has been visited more than 10 million times since it launched. The site includes extensive, easy to understand information about the health care law, including new rights and protections, coverage options, and how the Affordable Care Act will help consumers.
The website is the first of its kind to bring information and links to health insurance plans and other coverage options into one place, making it easy for consumers to learn about their insurance choices. And on November 18, 2011, HHS added a unique tool to allow small businesses to research and compare locally available insurance plans in an unbiased manner. As a result, small businesses now have easy access to plan data, such as out-of-pocket limits, average cost per enrollee, available deductibles and co-pay options (including services that are not covered and benefits available for purchase at additional costs), Health Savings Account eligibility, and more.
HealthCare.gov also gives consumers the tools they need to make the best decisions for themselves and their families, like information about rate increases. HealthCare.gov also provides details about the 80-20 rule (which requires insurers to spend at least 80 cents of every dollar on customers’ health care or quality improvements to it). A Spanish language version of the website (www.cuidadodesalud.gov) was launched on September 8, 2010.
In order to ensure a robust system of monitoring and evaluation as well as government transparency and accountability, the Office of the Assistant Secretary for Planning and Evaluation has designed a Health System Tracking Project. The Health System Tracking Project is a dynamic, web-based tool that displays data on key health indicators, compiled from across federal sources, along with descriptions of the measures and links to data sources. Good metrics will allow policymakers, providers and the public to monitor changes in health care quality, cost and access and enable them to understand the effects of these changes across the health care system.
In keeping with its commitment to transparency and accountability, HHS launched a new 10-year agenda for Healthy People 2020 in December 2010. Healthy People 2020 represents the fourth generation of decade-long disease prevention and health promotion goals for the nation. Its science-based, measurable objectives benchmark the nation’s health at the beginning of the decade, set 10-year targets, and help monitor and track progress over time. Tracking data, interventions, and other resources are easily accessible at the redesigned healthypeople.gov website. HHS developed Healthy People 2020 through a collaborative process that drew on expertise and input across multiple Federal agencies, state and local governments, academia, business, community and professional organizations, and members of the public.
Expand All
Strategic Goals & Objectives
Agencies establish a variety of organizational goals to drive progress toward key outcomes for the American people. Long-term strategic goals articulate clear statements of what the agency wants to achieve to advance its mission and address relevant national problems, needs, challenges and opportunities. Strategic objectives define the outcome or management impact the agency is trying to achieve, and also include the agency's role. Each strategic objective is tracked through a suite of performance goals, indicators and other evidence. Click here for more information on stakeholder engagement during goal development.
Strategic Goal:
Strengthen Health Care
Statement:
Strengthen Health Care
Strategic Objectives
Statement:
Make coverage more secure for those who have insurance, and extend affordable coverage to the uninsured
Description:
HHS is securing and extending health insurance by implementing provisions created by the Affordable Care Act such as working with states to set up health insurance exchanges, expanding Medicaid coverage to low-income Americans, and prohibiting insurance companies from dropping people when they get sick.
Statement:
Improve healthcare quality and patient safety.
Description:
HHS is improving healthcare quality and patient safety by developing physician- and hospital-quality reporting systems that link payments to the quality and efficiency of care and initiating a bundled-payment system that will align payments for services delivered across an episode of care, such as a heart bypass or hip replacement, rather than paying for services separately. HHS is also reducing healthcare-associated infections, adverse drug events, and other complications of healthcare delivery through quality and safety promotion efforts.
Priority Goal: Improve patient safety.
Statement:
To reduce the national rate of healthcare-associated infections (HAIs) by September 30, 2015 by demonstrating a 10% reduction in national hospital-acquired catheter-associated urinary tract infections (CAUTI) from the current SIR of 1.03 to a target SIR of 0.92.
Description:
At any given time, about one in every 25 hospitalized patients has a healthcare-associated infection while over 1 million HAIs occur across the U.S. healthcare system every year. These infections can lead to significant morbidity and mortality, with tens of thousands of lives lost each year.
Of these hospital-acquired events, catheter-associated urinary tract infections (CAUTI) are among the most common. Research has shown that a significant portion of these infections can be prevented, avoiding patient morbidity and mortality from this HAI while reducing costs accrued to the healthcare system.
The HAI Agency Priority Goal is to reduce the national rate of HAI by demonstrating significant, quantitative and measurable reductions in hospital-acquired CAUTI. As such; the FY2014-15 HAI Agency Priority Goal (APG) is to reduce the national CAUTI standardized infection ratio by 10% by September 2015 over the current 2012 baseline of 1.03. Of note, this SIR baseline was changed from 1.02 to 1.03 in this goal. This reflects the fact that the CDC released preliminary final numbers for 2012 in September 2013, the time at which this goal was written. However, hospitals still had through the end of the year to report final data to NHSN. Accounting for the last three months of data submitted by some hospitals caused a slight adjustment in the final (and thus baseline) 2012 SIR from 1.02 to 1.03. We make this adjustment in the HAI.APG to reflect the finalized SIR and to maintain consistency with other HAI reports moving forward.
As we carry this portion of the goal from the FY2011-13 goal, a concerted effort between the Centers for Medicare and Medicaid Services (CMS), Agency for Healthcare Research and Quality (AHRQ), Centers for Disease Control and Prevention (CDC), and Office of the Assistant Secretary of Health (OASH) will continue to be a crucial to meeting goal targets. The main US Department of Health and Human Services (HHS) operating divisions that constitute this workgroup will focus on applying their HAI programmatic efforts in a way that aligns strategy and metrics, provides consistent messaging to its audience, uses data to target those facilities in most need of improvement, and creates synergy to achieve CAUTI reduction outcomes.
We will continue to use combined HHS programmatic levers to contribute to the achievement of CAUTI targets. These initiatives include:
- Quality Improvement Organization (QIOs) Program
- Hospital Inpatient Quality Reporting (HIQR) Program
- Disseminating Data for Action using the National Healthcare Safety Network (NHSN)
- State HAI programs
- Partnership for Patients (PfP)
- Comprehensive Unit-based Safety Program (CUSP) for CAUTI Ongoing coordination through HAI strategic planning, HAI Regional and National Meetings
- Regular review and updates to the National Action Plan to prevent HAIs: "Roadmap to Elimination."
Attention to several factors are necessary to assess progress toward goals in this new period. As in the previous HAI goal and consistent with a measurement strategy used by a majority of hospitals that participate in national HAI reporting initiatives, this goal will use the standardized infection ratio (SIR) as the measure, NHSN, the CDC-run infection surveillance system as the primary data source and report data points on a biannual basis. A six month lag in data will remain in order to ensure the most complete and accurate data being reported out and minimize statistically insignificant variations in the data.
Lessons learned from the previous goal allow us to predict potential changes in the CAUTI SIR trend in the months following January 2015 now that CMS' Hospital Inpatient Quality Reporting (HIQR) program requires participating hospitals to report CAUTI in non-intensive care units to receive their full annual payment update. The influx of new CAUTI reporters in the middle of the previous 2011-13 HAI.APG was identified as one but not the sole, etiology behind an increase in the CAUTI SIR over the life of this goal. The differences in CAUTI SIRs in ICU and non-ICU settings along with the influx of new reporters among non-ICU locations in 2015 may impact this goal. The degree to which this could again be a factor again is unknown especially since through programmatic outreach, many hospitals already report non-ICU CAUTI data to NHSN voluntarily.
We also anticipate application of the new CAUTI definition, which went into effect January 1, 2015, to the APG data we will report in subsequent quarters. Because our baseline CAUTI SIR was calculated using the old CAUTI definition, a strategy to ensure continuity and validity of new SIR data across this goal has been established. The CDC will construct a new SIR by applying the new CAUTI definition to our current baseline SIR and data points proceeding January 1, 2015. In other words, we will translate SIR data including our baseline data prior to January 1st to SIR data that is reflective of the changes in the CAUTI definition. We will also be able to illustrate the CAUTI SIR baseline and trending data by applying the new vs the old definition in order to demonstrate the degree of difference or lack thereof resulting from this definitional change. CDC has changed the CAUTI definition in response to input from stakeholders and scientific data.The HAI Workgroup will present full details on the definition change in relation to this goal and our targeted CAUTI SIR reductions to HHS leadership in November of 2015.
Lastly, analysis of the CAUTI data continues to reveal marked difference in reductions between intensive care and non-intensive care units. Intensive care units have significantly higher SIRs, higher number of catheter-days, and show less reductions in these indicators of progress than in the non ICU setting. The difference in CAUTI reductions between ICUs and non-ICU settings have been highlighted in analysis of both NHSN and CUSP for CAUTI data. Given the fact that sicker patients are admitted in ICUs, retaining a urinary catheter for longer may be a rooted in practice necessity or provider belief that it is a necessity and so concentrating on behavioral and systems process change may need to be further emphasized as we work in this setting to reduce CAUTI. The 10% goal for CAUTI reduction in this APG effort represents a composite goal that reflects greater reductions in non-ICU settings and lesser reductions in ICUs. Improvements in CAUTI however, have been demonstrated in large scale improvement programs when actively engaged in embedding evidence-based infection control protocol and a culture of safety unit and facility-wide. It’s also important to note that preliminary projections through the first three quarters of 2015 continue to show a fall in the CAUTI SIR and an on-track trajectory for achieving the CAUTI goal target.
Statement:
Emphasize primary and preventive care linked with community prevention services
Description:
The Affordable Care Act is expanding insurance coverage for Americans, supporting improvements in primary care, and makings new investments in community-based prevention. As part of this effort, HHS is focusing on creating key linkages between health care and effective community prevention services that support healthy living and disease management.
Priority Goal: Reduce combustible tobacco use
Statement:
By December 31, 2015, reduce the annual adult combustible tobacco consumption in the United States from 1,342 cigarette equivalents per capita to 1,174 cigarette equivalents per capita, which will represent an approximate 12% decrease from the 2012 baseline.
Description:
Smoking and second hand smoke is the leading preventable cause of death in the United States, killing more than an estimated 480,000 people in the U.S. each year. For every smoker who dies from a smoking-attributable disease, another 30 live with a serious smoking-related disease. Smoking costs the U.S. more than $300 billion a year, including nearly $170 billion in direct medical costs, and more than $156 billion in lost productivity. An estimated 58 million nonsmoking Americans are exposed to secondhand smoke, which causes more than 41,000 deaths in non-smoking adults each year . While smoking among U.S. adults is down significantly from a decade ago, the decline in adult smoking rates has slowed, concurrent with reductions in state investments in tobacco control program. Fortunately, people who stop smoking greatly reduce their risk for disease and premature death. Smoking cessation lowers the risk for lung and other types of cancer; it reduces the risk for coronary heart disease, stroke, and peripheral vascular disease. .
In 2010, HHS issued Ending the Epidemic – A Tobacco Control Strategic Action Plan, outlining a set of comprehensive actions framed around four key Healthy People 2020 tobacco control objectives:
1) reduce tobacco use
2) reduce the initiation of tobacco use
3) increase successful cessation attempts by smokers
4) reduce the proportion of nonsmokers exposed to secondhand smoke.
The National Prevention Strategy, released in 2011, includes tobacco control as one of seven priorities across the U.S. Government.
In 2012, cigarette and smokeless tobacco companies spent more than $9.6 billion, more than $1 million per hour that year, on advertising and promotional expenses in the United States to attract new users, retain current users, increase consumption, and generate favorable attitudes toward smoking. There is also a growing concern regarding new tobacco products that are being marketed to smokers as alternatives for use in smoke-free environments. Dual use of cigarettes and other tobacco products can maintain tobacco addiction and use among smokers who might otherwise quit. The marketing of purported reduced-risk products may increase overall tobacco use. Consumer mistaken perceptions of the “safety” of these products may pose a continuing obstacle for tobacco control.
States continue to reduce funding for comprehensive tobacco control. Research has shown that progress to prevent initiation and promote cessation in comprehensive programs is reversed when funding is no longer sustained.
HHS engages with multiple stakeholders in implementing tobacco control activities, which include: Congress, the public, minority communities, groups affected by tobacco-related health disparities, state and local tobacco control officials, tobacco control and public health non-governmental organizations, the scientific & research community, and businesses.
The U.S. Congress has provided direction and support for tobacco control activities in the following legislative actions:
• The Patient Protection and Affordable Care Act
• The American Recovery and Reinvestment Act (ARRA)
• The Family Smoking Prevention and Tobacco Control Act (FSPTCA)
• The Children’s Health Insurance Program Reauthorization Act (CHIPRA)
HHS oversees tobacco control and prevention committees covered by the Federal Advisory Committee Act. All meetings of these committees are open to the public and offer opportunities for stakeholder feedback.
Statement:
Reduce the growth of healthcare costs while promoting high-value, effective care
Description:
HHS is identifying, testing, evaluating and expanding innovative payment and service delivery models to reduce program expenditures for Medicare, Medicaid, and CHIP, without compromising quality of care or patient health outcomes. HHS is establishing value-based payment policies, programs, and initiatives that reward providers for delivering high-quality and efficient care. In addition, HHS is exploring strategies to enable providers and payers to process financial and administrative transactions faster and at lower cost.
Priority Goal: Improve patient safety.
Statement:
To reduce the national rate of healthcare-associated infections (HAIs) by September 30, 2015 by demonstrating a 10% reduction in national hospital-acquired catheter-associated urinary tract infections (CAUTI) from the current SIR of 1.03 to a target SIR of 0.92.
Description:
At any given time, about one in every 25 hospitalized patients has a healthcare-associated infection while over 1 million HAIs occur across the U.S. healthcare system every year. These infections can lead to significant morbidity and mortality, with tens of thousands of lives lost each year.
Of these hospital-acquired events, catheter-associated urinary tract infections (CAUTI) are among the most common. Research has shown that a significant portion of these infections can be prevented, avoiding patient morbidity and mortality from this HAI while reducing costs accrued to the healthcare system.
The HAI Agency Priority Goal is to reduce the national rate of HAI by demonstrating significant, quantitative and measurable reductions in hospital-acquired CAUTI. As such; the FY2014-15 HAI Agency Priority Goal (APG) is to reduce the national CAUTI standardized infection ratio by 10% by September 2015 over the current 2012 baseline of 1.03. Of note, this SIR baseline was changed from 1.02 to 1.03 in this goal. This reflects the fact that the CDC released preliminary final numbers for 2012 in September 2013, the time at which this goal was written. However, hospitals still had through the end of the year to report final data to NHSN. Accounting for the last three months of data submitted by some hospitals caused a slight adjustment in the final (and thus baseline) 2012 SIR from 1.02 to 1.03. We make this adjustment in the HAI.APG to reflect the finalized SIR and to maintain consistency with other HAI reports moving forward.
As we carry this portion of the goal from the FY2011-13 goal, a concerted effort between the Centers for Medicare and Medicaid Services (CMS), Agency for Healthcare Research and Quality (AHRQ), Centers for Disease Control and Prevention (CDC), and Office of the Assistant Secretary of Health (OASH) will continue to be a crucial to meeting goal targets. The main US Department of Health and Human Services (HHS) operating divisions that constitute this workgroup will focus on applying their HAI programmatic efforts in a way that aligns strategy and metrics, provides consistent messaging to its audience, uses data to target those facilities in most need of improvement, and creates synergy to achieve CAUTI reduction outcomes.
We will continue to use combined HHS programmatic levers to contribute to the achievement of CAUTI targets. These initiatives include:
- Quality Improvement Organization (QIOs) Program
- Hospital Inpatient Quality Reporting (HIQR) Program
- Disseminating Data for Action using the National Healthcare Safety Network (NHSN)
- State HAI programs
- Partnership for Patients (PfP)
- Comprehensive Unit-based Safety Program (CUSP) for CAUTI Ongoing coordination through HAI strategic planning, HAI Regional and National Meetings
- Regular review and updates to the National Action Plan to prevent HAIs: "Roadmap to Elimination."
Attention to several factors are necessary to assess progress toward goals in this new period. As in the previous HAI goal and consistent with a measurement strategy used by a majority of hospitals that participate in national HAI reporting initiatives, this goal will use the standardized infection ratio (SIR) as the measure, NHSN, the CDC-run infection surveillance system as the primary data source and report data points on a biannual basis. A six month lag in data will remain in order to ensure the most complete and accurate data being reported out and minimize statistically insignificant variations in the data.
Lessons learned from the previous goal allow us to predict potential changes in the CAUTI SIR trend in the months following January 2015 now that CMS' Hospital Inpatient Quality Reporting (HIQR) program requires participating hospitals to report CAUTI in non-intensive care units to receive their full annual payment update. The influx of new CAUTI reporters in the middle of the previous 2011-13 HAI.APG was identified as one but not the sole, etiology behind an increase in the CAUTI SIR over the life of this goal. The differences in CAUTI SIRs in ICU and non-ICU settings along with the influx of new reporters among non-ICU locations in 2015 may impact this goal. The degree to which this could again be a factor again is unknown especially since through programmatic outreach, many hospitals already report non-ICU CAUTI data to NHSN voluntarily.
We also anticipate application of the new CAUTI definition, which went into effect January 1, 2015, to the APG data we will report in subsequent quarters. Because our baseline CAUTI SIR was calculated using the old CAUTI definition, a strategy to ensure continuity and validity of new SIR data across this goal has been established. The CDC will construct a new SIR by applying the new CAUTI definition to our current baseline SIR and data points proceeding January 1, 2015. In other words, we will translate SIR data including our baseline data prior to January 1st to SIR data that is reflective of the changes in the CAUTI definition. We will also be able to illustrate the CAUTI SIR baseline and trending data by applying the new vs the old definition in order to demonstrate the degree of difference or lack thereof resulting from this definitional change. CDC has changed the CAUTI definition in response to input from stakeholders and scientific data.The HAI Workgroup will present full details on the definition change in relation to this goal and our targeted CAUTI SIR reductions to HHS leadership in November of 2015.
Lastly, analysis of the CAUTI data continues to reveal marked difference in reductions between intensive care and non-intensive care units. Intensive care units have significantly higher SIRs, higher number of catheter-days, and show less reductions in these indicators of progress than in the non ICU setting. The difference in CAUTI reductions between ICUs and non-ICU settings have been highlighted in analysis of both NHSN and CUSP for CAUTI data. Given the fact that sicker patients are admitted in ICUs, retaining a urinary catheter for longer may be a rooted in practice necessity or provider belief that it is a necessity and so concentrating on behavioral and systems process change may need to be further emphasized as we work in this setting to reduce CAUTI. The 10% goal for CAUTI reduction in this APG effort represents a composite goal that reflects greater reductions in non-ICU settings and lesser reductions in ICUs. Improvements in CAUTI however, have been demonstrated in large scale improvement programs when actively engaged in embedding evidence-based infection control protocol and a culture of safety unit and facility-wide. It’s also important to note that preliminary projections through the first three quarters of 2015 continue to show a fall in the CAUTI SIR and an on-track trajectory for achieving the CAUTI goal target.
Statement:
Ensure access to quality, culturally competent care, including long-term services and supports, for vulnerable populations
Description:
With the growing diversity of the U.S. population, healthcare providers are increasingly called on to address their patient's unique social and cultural experience and language needs. The Affordable Care Act highlights minority health by formally establishing minority health offices in the Department's agencies, and contains provisions to improve data collection and analysis. HHS is working to address disparities by promoting access to quality primary care and preventive services, developing a diverse, culturally-competent workforce, and preventing discriminatory practices.
Statement:
Improve health care and population health through meaningful use of health information technology
Description:
At the heart of HHS’s strategy to strengthen and modernize the healthcare system is the use of data to improve healthcare quality, reduce unnecessary healthcare costs, decrease paperwork, expand access to affordable care, improve population health, and support reformed payment structures. To accomplish this, HHS is encouraging widespread adoption and meaningful use of health information technology through incentives, grants, and technical assistance.
Priority Goal: Improve health care through meaningful use of health information technology.
Statement:
By the end of FY2015, increase the number of eligible providers who receive incentive payments from the CMS Medicare and Medicaid EHR Incentive Programs for the successful adoption or demonstration of meaningful use of certified EHR technology to 450,000.
Description:
At the heart of HHS’s strategy to strengthen and modernize healthcare is the use of data to improve healthcare quality, reduce unnecessary healthcare costs, decrease paperwork, expand access to affordable care, improve population health, and support reformed payment structures. The nation’s health information technology infrastructure enables the flow of information to power these critical efforts— that can help facilitate the types of fundamental changes in access and healthcare delivery proposed in the Affordable Care Act. HHS is taking a leading role in realizing health information technology’s potential benefits. The Recovery Act provided an unprecedented investment in health information technology to propel a range of initiatives, including regulations on the meaningful use of health information technology and standards as well as the funding of Health IT Regional Extension Centers, State Health Information Exchanges, and other programs.
This Priority Goal is to increase the number of eligible providers in these important programs who adopt/meaningfully use electronic health records (EHRs), since it is believed that the increased use of EHRs will improve coordination across providers and settings, improve health care delivery, improve quality of care and reduce medical errors. The Office of the National Coordinator for Health IT within the Office of the Secretary of Health and Human Services is the designated lead for this priority goal in close partnership with the Centers for Medicare & Medicaid Services (CMS). A key step in this strategy is to provide incentive payments to eligible providers serving Medicare and Medicaid beneficiaries who adopt and meaningfully use certified EHR technology.
Detailed reports showing the provider types and EHR Incentive Programs breakouts are available on the CMS website at http://www.cms.gov/EHRIncentivePrograms/56_DataAndReports.asp
Priority Goals
Statement:
By December 31, 2015, reduce the annual adult combustible tobacco consumption in the United States from 1,342 cigarette equivalents per capita to 1,174 cigarette equivalents per capita, which will represent an approximate 12% decrease from the 2012 baseline.
Description:
Smoking and second hand smoke is the leading preventable cause of death in the United States, killing more than an estimated 480,000 people in the U.S. each year. For every smoker who dies from a smoking-attributable disease, another 30 live with a serious smoking-related disease. Smoking costs the U.S. more than $300 billion a year, including nearly $170 billion in direct medical costs, and more than $156 billion in lost productivity. An estimated 58 million nonsmoking Americans are exposed to secondhand smoke, which causes more than 41,000 deaths in non-smoking adults each year . While smoking among U.S. adults is down significantly from a decade ago, the decline in adult smoking rates has slowed, concurrent with reductions in state investments in tobacco control program. Fortunately, people who stop smoking greatly reduce their risk for disease and premature death. Smoking cessation lowers the risk for lung and other types of cancer; it reduces the risk for coronary heart disease, stroke, and peripheral vascular disease. .
In 2010, HHS issued Ending the Epidemic – A Tobacco Control Strategic Action Plan, outlining a set of comprehensive actions framed around four key Healthy People 2020 tobacco control objectives:
1) reduce tobacco use
2) reduce the initiation of tobacco use
3) increase successful cessation attempts by smokers
4) reduce the proportion of nonsmokers exposed to secondhand smoke.
The National Prevention Strategy, released in 2011, includes tobacco control as one of seven priorities across the U.S. Government.
In 2012, cigarette and smokeless tobacco companies spent more than $9.6 billion, more than $1 million per hour that year, on advertising and promotional expenses in the United States to attract new users, retain current users, increase consumption, and generate favorable attitudes toward smoking. There is also a growing concern regarding new tobacco products that are being marketed to smokers as alternatives for use in smoke-free environments. Dual use of cigarettes and other tobacco products can maintain tobacco addiction and use among smokers who might otherwise quit. The marketing of purported reduced-risk products may increase overall tobacco use. Consumer mistaken perceptions of the “safety” of these products may pose a continuing obstacle for tobacco control.
States continue to reduce funding for comprehensive tobacco control. Research has shown that progress to prevent initiation and promote cessation in comprehensive programs is reversed when funding is no longer sustained.
HHS engages with multiple stakeholders in implementing tobacco control activities, which include: Congress, the public, minority communities, groups affected by tobacco-related health disparities, state and local tobacco control officials, tobacco control and public health non-governmental organizations, the scientific & research community, and businesses.
The U.S. Congress has provided direction and support for tobacco control activities in the following legislative actions:
• The Patient Protection and Affordable Care Act
• The American Recovery and Reinvestment Act (ARRA)
• The Family Smoking Prevention and Tobacco Control Act (FSPTCA)
• The Children’s Health Insurance Program Reauthorization Act (CHIPRA)
HHS oversees tobacco control and prevention committees covered by the Federal Advisory Committee Act. All meetings of these committees are open to the public and offer opportunities for stakeholder feedback.
Statement:
To reduce the national rate of healthcare-associated infections (HAIs) by September 30, 2015 by demonstrating a 10% reduction in national hospital-acquired catheter-associated urinary tract infections (CAUTI) from the current SIR of 1.03 to a target SIR of 0.92.
Description:
At any given time, about one in every 25 hospitalized patients has a healthcare-associated infection while over 1 million HAIs occur across the U.S. healthcare system every year. These infections can lead to significant morbidity and mortality, with tens of thousands of lives lost each year.
Of these hospital-acquired events, catheter-associated urinary tract infections (CAUTI) are among the most common. Research has shown that a significant portion of these infections can be prevented, avoiding patient morbidity and mortality from this HAI while reducing costs accrued to the healthcare system.
The HAI Agency Priority Goal is to reduce the national rate of HAI by demonstrating significant, quantitative and measurable reductions in hospital-acquired CAUTI. As such; the FY2014-15 HAI Agency Priority Goal (APG) is to reduce the national CAUTI standardized infection ratio by 10% by September 2015 over the current 2012 baseline of 1.03. Of note, this SIR baseline was changed from 1.02 to 1.03 in this goal. This reflects the fact that the CDC released preliminary final numbers for 2012 in September 2013, the time at which this goal was written. However, hospitals still had through the end of the year to report final data to NHSN. Accounting for the last three months of data submitted by some hospitals caused a slight adjustment in the final (and thus baseline) 2012 SIR from 1.02 to 1.03. We make this adjustment in the HAI.APG to reflect the finalized SIR and to maintain consistency with other HAI reports moving forward.
As we carry this portion of the goal from the FY2011-13 goal, a concerted effort between the Centers for Medicare and Medicaid Services (CMS), Agency for Healthcare Research and Quality (AHRQ), Centers for Disease Control and Prevention (CDC), and Office of the Assistant Secretary of Health (OASH) will continue to be a crucial to meeting goal targets. The main US Department of Health and Human Services (HHS) operating divisions that constitute this workgroup will focus on applying their HAI programmatic efforts in a way that aligns strategy and metrics, provides consistent messaging to its audience, uses data to target those facilities in most need of improvement, and creates synergy to achieve CAUTI reduction outcomes.
We will continue to use combined HHS programmatic levers to contribute to the achievement of CAUTI targets. These initiatives include:
- Quality Improvement Organization (QIOs) Program
- Hospital Inpatient Quality Reporting (HIQR) Program
- Disseminating Data for Action using the National Healthcare Safety Network (NHSN)
- State HAI programs
- Partnership for Patients (PfP)
- Comprehensive Unit-based Safety Program (CUSP) for CAUTI Ongoing coordination through HAI strategic planning, HAI Regional and National Meetings
- Regular review and updates to the National Action Plan to prevent HAIs: "Roadmap to Elimination."
Attention to several factors are necessary to assess progress toward goals in this new period. As in the previous HAI goal and consistent with a measurement strategy used by a majority of hospitals that participate in national HAI reporting initiatives, this goal will use the standardized infection ratio (SIR) as the measure, NHSN, the CDC-run infection surveillance system as the primary data source and report data points on a biannual basis. A six month lag in data will remain in order to ensure the most complete and accurate data being reported out and minimize statistically insignificant variations in the data.
Lessons learned from the previous goal allow us to predict potential changes in the CAUTI SIR trend in the months following January 2015 now that CMS' Hospital Inpatient Quality Reporting (HIQR) program requires participating hospitals to report CAUTI in non-intensive care units to receive their full annual payment update. The influx of new CAUTI reporters in the middle of the previous 2011-13 HAI.APG was identified as one but not the sole, etiology behind an increase in the CAUTI SIR over the life of this goal. The differences in CAUTI SIRs in ICU and non-ICU settings along with the influx of new reporters among non-ICU locations in 2015 may impact this goal. The degree to which this could again be a factor again is unknown especially since through programmatic outreach, many hospitals already report non-ICU CAUTI data to NHSN voluntarily.
We also anticipate application of the new CAUTI definition, which went into effect January 1, 2015, to the APG data we will report in subsequent quarters. Because our baseline CAUTI SIR was calculated using the old CAUTI definition, a strategy to ensure continuity and validity of new SIR data across this goal has been established. The CDC will construct a new SIR by applying the new CAUTI definition to our current baseline SIR and data points proceeding January 1, 2015. In other words, we will translate SIR data including our baseline data prior to January 1st to SIR data that is reflective of the changes in the CAUTI definition. We will also be able to illustrate the CAUTI SIR baseline and trending data by applying the new vs the old definition in order to demonstrate the degree of difference or lack thereof resulting from this definitional change. CDC has changed the CAUTI definition in response to input from stakeholders and scientific data.The HAI Workgroup will present full details on the definition change in relation to this goal and our targeted CAUTI SIR reductions to HHS leadership in November of 2015.
Lastly, analysis of the CAUTI data continues to reveal marked difference in reductions between intensive care and non-intensive care units. Intensive care units have significantly higher SIRs, higher number of catheter-days, and show less reductions in these indicators of progress than in the non ICU setting. The difference in CAUTI reductions between ICUs and non-ICU settings have been highlighted in analysis of both NHSN and CUSP for CAUTI data. Given the fact that sicker patients are admitted in ICUs, retaining a urinary catheter for longer may be a rooted in practice necessity or provider belief that it is a necessity and so concentrating on behavioral and systems process change may need to be further emphasized as we work in this setting to reduce CAUTI. The 10% goal for CAUTI reduction in this APG effort represents a composite goal that reflects greater reductions in non-ICU settings and lesser reductions in ICUs. Improvements in CAUTI however, have been demonstrated in large scale improvement programs when actively engaged in embedding evidence-based infection control protocol and a culture of safety unit and facility-wide. It’s also important to note that preliminary projections through the first three quarters of 2015 continue to show a fall in the CAUTI SIR and an on-track trajectory for achieving the CAUTI goal target.
Strategic Goal:
Advance Scientific Knowledge and Innovation
Statement:
Advance Scientific Knowledge and Innovation
Strategic Objectives
Statement:
Accelerate the process of scientific discovery to improve health
Description:
Continuing to improve the health and well-being of Americans requires HHS investments, ranging from improving its understanding of fundamental biological processes to identifying the best modes of prevention and treatment. HHS is accelerating movement along the pipeline from scientific discovery to more effective patient care to improve the health of Americans.
Statement:
Foster and apply innovative solutions to health, public health, and human services challenges
Description:
By promoting agency transparency, public participation, and public-private collaboration, HHS is creating an environment which can harness the energy and expertise of federal and nonfederal partners to find innovative solutions to health, public health, and human services challenges. HHS is taking action to inspire the development of products and services that can improve health and health care, increase the speed and predictability of medical product reviews, hold down health care costs, and expedite development of breakthrough therapies can better treat life-threatening diseases.
Statement:
Advance the regulatory sciences to enhance food safety, improve medical product development, and support tobacco regulation
Description:
Advances and innovations in regulatory science will benefit every American by increasing the accuracy and efficiency of regulatory review, and by reducing adverse drug events, drug development costs, and time to market for new medical technologies. Regulatory science also helps to prevent foodborne illnesses and limit the impact of outbreaks when they do occur. Tobacco regulatory science at HHS seeks to reduce the morbidity and mortality from tobacco use, including by preventing children and youth from ever starting to use tobacco.
Statement:
Increase our understanding of what works in public health and human service practice
Description:
Working together with its public and private partners, HHS is committed to improving the quality of public health and human service practice by conducting applied, translational, and operations research and evaluations. HHS also monitors and evaluates programs to assess efficiency and responsiveness and to ensure the effective use of information in strategic planning, program or policy decision making, and program improvement.
Statement:
Improve laboratory, surveillance, and epidemiology capacity
Description:
Three critical elements underpin public health practice: laboratory, surveillance, and epidemiological services. HHS is working at the national, state, local, and tribal levels to achieve this objective, by enhancing the capacity of these services, identifying and addressing gaps in knowledge, training, and skills, and supporting service integration and data exchange to better identify and respond to health threats.
Strategic Goal:
Advance the Health, Safety, and Well-Being of the American People
Statement:
Advance the Health, Safety, and Well-Being of the American People
Strategic Objectives
Statement:
Promote the safety, well-being, resilience and healthy development of children and youth
Description:
HHS partners with service providers to sustain an essential safety net of services that protect children and youth, promote their emotional health and resilience in the face of adversity, and ensure their healthy development from birth through the transition to adulthood. HHS also works to achieve this objective by identifying and implementing evidence-based interventions; promoting greater coordination across programs; and strengthening the human services workforce.
Priority Goal: Improve the quality of early childhood education.
Statement:
By September 30, 2015, improve the quality of early childhood programs for low-income children through implementation of the Quality Rating and Improvement Systems in the Child Care and Development Fund, and through implementation of the Classroom Assessment Scoring System in Head Start.
Description:
This Priority Goal calls for actions in FY 2014 and FY 2015 to improve the quality of early childhood education programs for low-income children. For the ACF Child Care program, the goal is to increase the number of states with Quality Rating and Improvement Systems (QRIS) that meet the seven high quality benchmarks for child care and other early childhood programs, developed by HHS. QRIS is a mechanism by which to improve the quality of child care available in communities and increase parents’ knowledge and understanding of the child care options available to them. In order for a QRIS to be considered as meeting high-quality benchmarks, it must 1) be statewide; 2) be eligible to child care centers and family child care homes; 3) include quality improvement indicators that cover learning environments and curriculum, teacher/practitioner standards, and family partnerships and strengthening; 4) use training or on-site consultation to help child care programs attain or maintain quality improvement standards beyond licensing; 5) offer financial incentives for maintaining or increasing quality to child care centers and family child care homes; 6) include quality assessments of child care centers and family child care homes; and 7) use symbols or simple icons that indicate levels of quality as part of resource and referral/consumer education services to parents seeking child care. For FY 2011, a baseline of 17 states had implemented a QRIS that met all outlined high quality benchmarks. The baseline was calculated using FY 2012-2013 State Plans that were submitted in September 2011. In FY 2014, 29 states had a QRIS that met high quality benchmarks, meeting the previously established target. States expanded from pilot programs to statewide-systems and increased availability to quality information, leading them to meet more components of the QRIS measure. States were also supported by targeted technical assistance through state specific benchmarks and goals. The FY 2014 results show that states continue to make progress toward implementing QRIS that meet high-quality benchmarks, and the ACF Office of Child Care (OCC) has established a target of 32 states for FY 2015.
Currently, many states meet some, but not all seven, of the outlined benchmarks. States are making significant progress toward implementing a comprehensive QRIS that meets all outlined quality benchmarks; however, their progress is masked by the single figure reported. To provide a more complete picture of QRIS implementation and improvements across the country, OCC is closely tracking the progress of states that may not meet all quality benchmarks, but that have demonstrated improvements by increasing the number of benchmarks reached. For example, as of FY 2014, at least six states have incorporated six quality benchmarks and at least six states have incorporated five quality benchmarks. Between FY 2011 and FY 2014, 27 states and territories have made progress on at least one of the components of the measure. In addition, targeted technical assistance provided by the new National Center on Early Childhood Quality Assurance, as well as other technical assistance partners funded by ACF, will continue to help states work toward their goal of improving their QRIS.
Also as part of this Priority Goal, the ACF Office of Head Start (OHS) is striving to increase the percentage of Head Start children in high quality classrooms. Progress is measured by reducing the proportion of Head Start grantees scoring in the low range in any domain of the Classroom Assessment Scoring System (CLASS: Pre-K). This research-based tool measures teacher-child interaction on a seven-point scale in three broad domains: Emotional Support, Classroom Organization, and Instructional Support. OHS successfully began data collection using random samples for the CLASS: Pre-K in the first quarter of FY 2012. Analysis of the full data set of CLASS scores for the cohort of 388 Head Start grantees that received on-site monitoring in the 2011-2012 Head Start “school year” occurred in October of 2012, and OHS established a baseline of 25 percent scoring in the low range.
An analysis of CLASS scores for the most recent cohort of 404 Head Start grantees that received on-site monitoring in the 2013-2014 Head Start “school year” (FY 2014 actual result) indicates that 23 percent of grantees scored in the low range, thus meeting the target of 27 percent. All grantees scoring in the low range (below 2.5) in FY 2014 did so for the Instructional Support domain. (Nationwide for the CLASS: Pre-K tool, scores are typically higher in the domains of Emotional Support and Classroom Organization than in the domain of Instructional Support.)
The FY 2014 result is a signicant improvement relative to the previous FY 2013 result, when the number of grantees scoring below a 2.5 was 31 percent. In response to the data from the FY 2013 CLASS reviews, OHS developed a system to provide more intentional targeted assistance to those grantees that score in the low range on CLASS. OHS is continuing to flag grantees that score in the low range, conduct more analyses on the specific dimension level, which are specific elements or skill areas within each of the three domains, and providing periodic reports to its Regional Offices so they can direct their TTA to specific grantees. For example, concept development, quality of feedback, and language modeling are the three dimensions within the domain of Instructional Support. Providing TTA at the more specific dimension-level supports grantees to focus in on the skills that need improvement.
There are some challenges to making progress in these areas. In the past two decades, a growing body of evidence has established the importance of quality child care in promoting healthy child development and school readiness and success for children. However, systemic changes take time to implement, and states are at different starting points. In the FY 2016 Budget request to Congress, the President continued to build a continuum of high-quality early childhood programs, including proposing an historic investment of $82 billion over 10 years to increase the availability of high-quality child care for children under four years old. On November 19, 2014, the President signed into the law the first statutory reauthorization of the Child Care and Development Block Grant (CCDBG) program since 1996, which aims to move children receiving subsidies into high-quality child care settings. Among a comprehensive array of reforms, the new statute includes an increased focus on improving the quality of child care through systemic quality investments, which will help move states toward meeting this priority performance goal. In addition, the statute includes provisions requiring states to evaluate the measurable outcomes of their quality improvement activities. OCC is gathering information about QRIS implementation through the CCDBG Plan and the annual quality performance report, as well as providing states with targeted technical assistance through state specific technical assistance plans and goals. ACF recently announced the Early Childhood Training and Technical Assistance System, which transforms the current TA system for child care, T/TA for Head Start, and related programs into a coordinated system that will provide training, resources and materials to multiple stakeholder groups at regional, state and local levels to support school readiness. The new National Center on Early Childhood Quality Assurance will help OCC continue to support the infrastructure of an early childhood education quality improvement framework, including QRIS.
Additionally, with respect to Head Start, there are 50,000 Head Start and Early Head Start classrooms across the country in diverse settings ranging from New York City to the bottom of the Grand Canyon. Changing teacher behavior and practices at the ground level to improve the quality of the classroom is a formidable challenge, particularly in highly rural areas, American Indian and Alaska Native programs, and Migrant and Seasonal Head Start programs where finding qualified staff can be difficult due to more limited access to higher education. OHS is using multiple approaches to address this challenge, including policy levers, training and technical assistance, and professional development efforts.
Statement:
Promote economic and social well-being for individuals, families and communities
Description:
HHS agencies work together and collaborate across Federal departments to maximize the potential benefits of various programs, services, and policies designed to improve the well-being of individuals, families, and communities. Many HHS agencies fund essential human services to those who are least able to help themselves, often through the Department’s state, local, and tribal partners.
Priority Goal: Improve the quality of early childhood education.
Statement:
By September 30, 2015, improve the quality of early childhood programs for low-income children through implementation of the Quality Rating and Improvement Systems in the Child Care and Development Fund, and through implementation of the Classroom Assessment Scoring System in Head Start.
Description:
This Priority Goal calls for actions in FY 2014 and FY 2015 to improve the quality of early childhood education programs for low-income children. For the ACF Child Care program, the goal is to increase the number of states with Quality Rating and Improvement Systems (QRIS) that meet the seven high quality benchmarks for child care and other early childhood programs, developed by HHS. QRIS is a mechanism by which to improve the quality of child care available in communities and increase parents’ knowledge and understanding of the child care options available to them. In order for a QRIS to be considered as meeting high-quality benchmarks, it must 1) be statewide; 2) be eligible to child care centers and family child care homes; 3) include quality improvement indicators that cover learning environments and curriculum, teacher/practitioner standards, and family partnerships and strengthening; 4) use training or on-site consultation to help child care programs attain or maintain quality improvement standards beyond licensing; 5) offer financial incentives for maintaining or increasing quality to child care centers and family child care homes; 6) include quality assessments of child care centers and family child care homes; and 7) use symbols or simple icons that indicate levels of quality as part of resource and referral/consumer education services to parents seeking child care. For FY 2011, a baseline of 17 states had implemented a QRIS that met all outlined high quality benchmarks. The baseline was calculated using FY 2012-2013 State Plans that were submitted in September 2011. In FY 2014, 29 states had a QRIS that met high quality benchmarks, meeting the previously established target. States expanded from pilot programs to statewide-systems and increased availability to quality information, leading them to meet more components of the QRIS measure. States were also supported by targeted technical assistance through state specific benchmarks and goals. The FY 2014 results show that states continue to make progress toward implementing QRIS that meet high-quality benchmarks, and the ACF Office of Child Care (OCC) has established a target of 32 states for FY 2015.
Currently, many states meet some, but not all seven, of the outlined benchmarks. States are making significant progress toward implementing a comprehensive QRIS that meets all outlined quality benchmarks; however, their progress is masked by the single figure reported. To provide a more complete picture of QRIS implementation and improvements across the country, OCC is closely tracking the progress of states that may not meet all quality benchmarks, but that have demonstrated improvements by increasing the number of benchmarks reached. For example, as of FY 2014, at least six states have incorporated six quality benchmarks and at least six states have incorporated five quality benchmarks. Between FY 2011 and FY 2014, 27 states and territories have made progress on at least one of the components of the measure. In addition, targeted technical assistance provided by the new National Center on Early Childhood Quality Assurance, as well as other technical assistance partners funded by ACF, will continue to help states work toward their goal of improving their QRIS.
Also as part of this Priority Goal, the ACF Office of Head Start (OHS) is striving to increase the percentage of Head Start children in high quality classrooms. Progress is measured by reducing the proportion of Head Start grantees scoring in the low range in any domain of the Classroom Assessment Scoring System (CLASS: Pre-K). This research-based tool measures teacher-child interaction on a seven-point scale in three broad domains: Emotional Support, Classroom Organization, and Instructional Support. OHS successfully began data collection using random samples for the CLASS: Pre-K in the first quarter of FY 2012. Analysis of the full data set of CLASS scores for the cohort of 388 Head Start grantees that received on-site monitoring in the 2011-2012 Head Start “school year” occurred in October of 2012, and OHS established a baseline of 25 percent scoring in the low range.
An analysis of CLASS scores for the most recent cohort of 404 Head Start grantees that received on-site monitoring in the 2013-2014 Head Start “school year” (FY 2014 actual result) indicates that 23 percent of grantees scored in the low range, thus meeting the target of 27 percent. All grantees scoring in the low range (below 2.5) in FY 2014 did so for the Instructional Support domain. (Nationwide for the CLASS: Pre-K tool, scores are typically higher in the domains of Emotional Support and Classroom Organization than in the domain of Instructional Support.)
The FY 2014 result is a signicant improvement relative to the previous FY 2013 result, when the number of grantees scoring below a 2.5 was 31 percent. In response to the data from the FY 2013 CLASS reviews, OHS developed a system to provide more intentional targeted assistance to those grantees that score in the low range on CLASS. OHS is continuing to flag grantees that score in the low range, conduct more analyses on the specific dimension level, which are specific elements or skill areas within each of the three domains, and providing periodic reports to its Regional Offices so they can direct their TTA to specific grantees. For example, concept development, quality of feedback, and language modeling are the three dimensions within the domain of Instructional Support. Providing TTA at the more specific dimension-level supports grantees to focus in on the skills that need improvement.
There are some challenges to making progress in these areas. In the past two decades, a growing body of evidence has established the importance of quality child care in promoting healthy child development and school readiness and success for children. However, systemic changes take time to implement, and states are at different starting points. In the FY 2016 Budget request to Congress, the President continued to build a continuum of high-quality early childhood programs, including proposing an historic investment of $82 billion over 10 years to increase the availability of high-quality child care for children under four years old. On November 19, 2014, the President signed into the law the first statutory reauthorization of the Child Care and Development Block Grant (CCDBG) program since 1996, which aims to move children receiving subsidies into high-quality child care settings. Among a comprehensive array of reforms, the new statute includes an increased focus on improving the quality of child care through systemic quality investments, which will help move states toward meeting this priority performance goal. In addition, the statute includes provisions requiring states to evaluate the measurable outcomes of their quality improvement activities. OCC is gathering information about QRIS implementation through the CCDBG Plan and the annual quality performance report, as well as providing states with targeted technical assistance through state specific technical assistance plans and goals. ACF recently announced the Early Childhood Training and Technical Assistance System, which transforms the current TA system for child care, T/TA for Head Start, and related programs into a coordinated system that will provide training, resources and materials to multiple stakeholder groups at regional, state and local levels to support school readiness. The new National Center on Early Childhood Quality Assurance will help OCC continue to support the infrastructure of an early childhood education quality improvement framework, including QRIS.
Additionally, with respect to Head Start, there are 50,000 Head Start and Early Head Start classrooms across the country in diverse settings ranging from New York City to the bottom of the Grand Canyon. Changing teacher behavior and practices at the ground level to improve the quality of the classroom is a formidable challenge, particularly in highly rural areas, American Indian and Alaska Native programs, and Migrant and Seasonal Head Start programs where finding qualified staff can be difficult due to more limited access to higher education. OHS is using multiple approaches to address this challenge, including policy levers, training and technical assistance, and professional development efforts.
Statement:
Improve the accessibility and quality of supportive services for people with disabilities and older adults
Description:
HHS programs and initiatives have special significance for older adults and people of all ages who have disabilities. Older adults and individuals with disabilities may need services and supports to assist them in performing routine activities of daily living such as eating and dressing. Improving access to, and the quality of, supports and services for older adults and people with disabilities is an HHS policy priority and is seen throughout HHS programs.
Statement:No Data Available
Description:
HHS works to promote prevention and wellness across its programs and agencies. As the Nation's principal prevention agency, CDC has primary responsibility for addressing chronic diseases through population and community health activities; working to support State, local, and tribal public health agencies; promoting health through education; and conducting outreach to vulnerable populations. Over the next several years, HHS's focus will be on creating environments that promote healthy behaviors to address the chronic diseases and health conditions that result in the most deaths, disability, and costs.
Priority Goal: Reduce combustible tobacco use
Statement:
By December 31, 2015, reduce the annual adult combustible tobacco consumption in the United States from 1,342 cigarette equivalents per capita to 1,174 cigarette equivalents per capita, which will represent an approximate 12% decrease from the 2012 baseline.
Description:
Smoking and second hand smoke is the leading preventable cause of death in the United States, killing more than an estimated 480,000 people in the U.S. each year. For every smoker who dies from a smoking-attributable disease, another 30 live with a serious smoking-related disease. Smoking costs the U.S. more than $300 billion a year, including nearly $170 billion in direct medical costs, and more than $156 billion in lost productivity. An estimated 58 million nonsmoking Americans are exposed to secondhand smoke, which causes more than 41,000 deaths in non-smoking adults each year . While smoking among U.S. adults is down significantly from a decade ago, the decline in adult smoking rates has slowed, concurrent with reductions in state investments in tobacco control program. Fortunately, people who stop smoking greatly reduce their risk for disease and premature death. Smoking cessation lowers the risk for lung and other types of cancer; it reduces the risk for coronary heart disease, stroke, and peripheral vascular disease. .
In 2010, HHS issued Ending the Epidemic – A Tobacco Control Strategic Action Plan, outlining a set of comprehensive actions framed around four key Healthy People 2020 tobacco control objectives:
1) reduce tobacco use
2) reduce the initiation of tobacco use
3) increase successful cessation attempts by smokers
4) reduce the proportion of nonsmokers exposed to secondhand smoke.
The National Prevention Strategy, released in 2011, includes tobacco control as one of seven priorities across the U.S. Government.
In 2012, cigarette and smokeless tobacco companies spent more than $9.6 billion, more than $1 million per hour that year, on advertising and promotional expenses in the United States to attract new users, retain current users, increase consumption, and generate favorable attitudes toward smoking. There is also a growing concern regarding new tobacco products that are being marketed to smokers as alternatives for use in smoke-free environments. Dual use of cigarettes and other tobacco products can maintain tobacco addiction and use among smokers who might otherwise quit. The marketing of purported reduced-risk products may increase overall tobacco use. Consumer mistaken perceptions of the “safety” of these products may pose a continuing obstacle for tobacco control.
States continue to reduce funding for comprehensive tobacco control. Research has shown that progress to prevent initiation and promote cessation in comprehensive programs is reversed when funding is no longer sustained.
HHS engages with multiple stakeholders in implementing tobacco control activities, which include: Congress, the public, minority communities, groups affected by tobacco-related health disparities, state and local tobacco control officials, tobacco control and public health non-governmental organizations, the scientific & research community, and businesses.
The U.S. Congress has provided direction and support for tobacco control activities in the following legislative actions:
• The Patient Protection and Affordable Care Act
• The American Recovery and Reinvestment Act (ARRA)
• The Family Smoking Prevention and Tobacco Control Act (FSPTCA)
• The Children’s Health Insurance Program Reauthorization Act (CHIPRA)
HHS oversees tobacco control and prevention committees covered by the Federal Advisory Committee Act. All meetings of these committees are open to the public and offer opportunities for stakeholder feedback.
Statement:
Reduce the occurrence of infectious diseases
Description:
Addressing infectious diseases - including vaccine-preventable diseases, foodborne illnesses, HIV/AIDS and associated sexually transmitted infections, hepatitis, tuberculosis, health care-associated infections, novel influenza viruses, and infections transmitted by animals and insects - is an HHS priority. HHS is working with its governmental and nongovernmental partners to strengthen basic and applied research, surveillance, diagnosis, and treatment efforts to reduce the burden of infectious diseases in the U.S. and throughout the world.
Priority Goal: Improve patient safety.
Statement:
To reduce the national rate of healthcare-associated infections (HAIs) by September 30, 2015 by demonstrating a 10% reduction in national hospital-acquired catheter-associated urinary tract infections (CAUTI) from the current SIR of 1.03 to a target SIR of 0.92.
Description:
At any given time, about one in every 25 hospitalized patients has a healthcare-associated infection while over 1 million HAIs occur across the U.S. healthcare system every year. These infections can lead to significant morbidity and mortality, with tens of thousands of lives lost each year.
Of these hospital-acquired events, catheter-associated urinary tract infections (CAUTI) are among the most common. Research has shown that a significant portion of these infections can be prevented, avoiding patient morbidity and mortality from this HAI while reducing costs accrued to the healthcare system.
The HAI Agency Priority Goal is to reduce the national rate of HAI by demonstrating significant, quantitative and measurable reductions in hospital-acquired CAUTI. As such; the FY2014-15 HAI Agency Priority Goal (APG) is to reduce the national CAUTI standardized infection ratio by 10% by September 2015 over the current 2012 baseline of 1.03. Of note, this SIR baseline was changed from 1.02 to 1.03 in this goal. This reflects the fact that the CDC released preliminary final numbers for 2012 in September 2013, the time at which this goal was written. However, hospitals still had through the end of the year to report final data to NHSN. Accounting for the last three months of data submitted by some hospitals caused a slight adjustment in the final (and thus baseline) 2012 SIR from 1.02 to 1.03. We make this adjustment in the HAI.APG to reflect the finalized SIR and to maintain consistency with other HAI reports moving forward.
As we carry this portion of the goal from the FY2011-13 goal, a concerted effort between the Centers for Medicare and Medicaid Services (CMS), Agency for Healthcare Research and Quality (AHRQ), Centers for Disease Control and Prevention (CDC), and Office of the Assistant Secretary of Health (OASH) will continue to be a crucial to meeting goal targets. The main US Department of Health and Human Services (HHS) operating divisions that constitute this workgroup will focus on applying their HAI programmatic efforts in a way that aligns strategy and metrics, provides consistent messaging to its audience, uses data to target those facilities in most need of improvement, and creates synergy to achieve CAUTI reduction outcomes.
We will continue to use combined HHS programmatic levers to contribute to the achievement of CAUTI targets. These initiatives include:
- Quality Improvement Organization (QIOs) Program
- Hospital Inpatient Quality Reporting (HIQR) Program
- Disseminating Data for Action using the National Healthcare Safety Network (NHSN)
- State HAI programs
- Partnership for Patients (PfP)
- Comprehensive Unit-based Safety Program (CUSP) for CAUTI Ongoing coordination through HAI strategic planning, HAI Regional and National Meetings
- Regular review and updates to the National Action Plan to prevent HAIs: "Roadmap to Elimination."
Attention to several factors are necessary to assess progress toward goals in this new period. As in the previous HAI goal and consistent with a measurement strategy used by a majority of hospitals that participate in national HAI reporting initiatives, this goal will use the standardized infection ratio (SIR) as the measure, NHSN, the CDC-run infection surveillance system as the primary data source and report data points on a biannual basis. A six month lag in data will remain in order to ensure the most complete and accurate data being reported out and minimize statistically insignificant variations in the data.
Lessons learned from the previous goal allow us to predict potential changes in the CAUTI SIR trend in the months following January 2015 now that CMS' Hospital Inpatient Quality Reporting (HIQR) program requires participating hospitals to report CAUTI in non-intensive care units to receive their full annual payment update. The influx of new CAUTI reporters in the middle of the previous 2011-13 HAI.APG was identified as one but not the sole, etiology behind an increase in the CAUTI SIR over the life of this goal. The differences in CAUTI SIRs in ICU and non-ICU settings along with the influx of new reporters among non-ICU locations in 2015 may impact this goal. The degree to which this could again be a factor again is unknown especially since through programmatic outreach, many hospitals already report non-ICU CAUTI data to NHSN voluntarily.
We also anticipate application of the new CAUTI definition, which went into effect January 1, 2015, to the APG data we will report in subsequent quarters. Because our baseline CAUTI SIR was calculated using the old CAUTI definition, a strategy to ensure continuity and validity of new SIR data across this goal has been established. The CDC will construct a new SIR by applying the new CAUTI definition to our current baseline SIR and data points proceeding January 1, 2015. In other words, we will translate SIR data including our baseline data prior to January 1st to SIR data that is reflective of the changes in the CAUTI definition. We will also be able to illustrate the CAUTI SIR baseline and trending data by applying the new vs the old definition in order to demonstrate the degree of difference or lack thereof resulting from this definitional change. CDC has changed the CAUTI definition in response to input from stakeholders and scientific data.The HAI Workgroup will present full details on the definition change in relation to this goal and our targeted CAUTI SIR reductions to HHS leadership in November of 2015.
Lastly, analysis of the CAUTI data continues to reveal marked difference in reductions between intensive care and non-intensive care units. Intensive care units have significantly higher SIRs, higher number of catheter-days, and show less reductions in these indicators of progress than in the non ICU setting. The difference in CAUTI reductions between ICUs and non-ICU settings have been highlighted in analysis of both NHSN and CUSP for CAUTI data. Given the fact that sicker patients are admitted in ICUs, retaining a urinary catheter for longer may be a rooted in practice necessity or provider belief that it is a necessity and so concentrating on behavioral and systems process change may need to be further emphasized as we work in this setting to reduce CAUTI. The 10% goal for CAUTI reduction in this APG effort represents a composite goal that reflects greater reductions in non-ICU settings and lesser reductions in ICUs. Improvements in CAUTI however, have been demonstrated in large scale improvement programs when actively engaged in embedding evidence-based infection control protocol and a culture of safety unit and facility-wide. It’s also important to note that preliminary projections through the first three quarters of 2015 continue to show a fall in the CAUTI SIR and an on-track trajectory for achieving the CAUTI goal target.
Priority Goal: Reduce foodborne illness in the population.
Statement:
By December 31, 2015, decrease the rate of Salmonella Enteritidis illness in the population from 2.6 cases per 100,000 (2007-2009 baseline) to 1.9 cases per 100,000.
Description:
Salmonella is the leading known cause of bacterial foodborne illness and death in the United States. Each year in the United States, Salmonella causes an estimated 1.2 million illnesses, including fever and diarrhea, and between 400 and 500 deaths. Salmonella serotype Enteritidis (SE), a subtype of Salmonella, is now the most common type of Salmonella in the United States and accounts for approximately 20% of all Salmonella cases in humans. The most significant sources of foodborne SE infections are shell eggs (FDA-regulated) and broiler chickens (USDA-regulated). Therefore, reducing SE illness from shell eggs is the most appropriate FDA strategy for reducing illness from SE. Preventing Salmonella infections depends on actions taken by regulatory agencies, the food industry and consumers to reduce contamination of food, as well as actions taken for detecting and responding to outbreaks. As part of the shared vision to reduce foodborne illness, HHS's Food and Drug Administration (FDA) has developed a Priority Goal to reduce Salmonella contamination in shell eggs, and the Centers for Disease Control and Prevention (CDC) is working with FDA to gather more data to better estimate sources of illness. Additionally, USDA, FDA and CDC are involved in many interagency efforts, including the Interagency Food Safety Analytics Collaboration (IFSAC). This interagency collaboration is working to improve methods used to estimate the proportion of foodborne illnesses associated with specific sources.
Statement:
Protect Americans’ health and safety during emergencies, and foster resilience to withstand and respond to emergencies
Description:
Over the past decade, our Nation has renewed its efforts to address large-scale incidents that have threatened human health, such as natural disasters, disease outbreaks, and terrorism. Working with its Federal, State, local, tribal, and international partners, HHS continues to support capacity-building efforts and strengthened linkages between government, nongovernmental organizations, and the private sector. HHS is now guided by the first National Health Security Strategy, a comprehensive framework for how the entire Nation must work together to protect people's health in the case of an emergency.
Priority Goals
Statement:
By December 31, 2015, decrease the rate of Salmonella Enteritidis illness in the population from 2.6 cases per 100,000 (2007-2009 baseline) to 1.9 cases per 100,000.
Description:
Salmonella is the leading known cause of bacterial foodborne illness and death in the United States. Each year in the United States, Salmonella causes an estimated 1.2 million illnesses, including fever and diarrhea, and between 400 and 500 deaths. Salmonella serotype Enteritidis (SE), a subtype of Salmonella, is now the most common type of Salmonella in the United States and accounts for approximately 20% of all Salmonella cases in humans. The most significant sources of foodborne SE infections are shell eggs (FDA-regulated) and broiler chickens (USDA-regulated). Therefore, reducing SE illness from shell eggs is the most appropriate FDA strategy for reducing illness from SE. Preventing Salmonella infections depends on actions taken by regulatory agencies, the food industry and consumers to reduce contamination of food, as well as actions taken for detecting and responding to outbreaks. As part of the shared vision to reduce foodborne illness, HHS's Food and Drug Administration (FDA) has developed a Priority Goal to reduce Salmonella contamination in shell eggs, and the Centers for Disease Control and Prevention (CDC) is working with FDA to gather more data to better estimate sources of illness. Additionally, USDA, FDA and CDC are involved in many interagency efforts, including the Interagency Food Safety Analytics Collaboration (IFSAC). This interagency collaboration is working to improve methods used to estimate the proportion of foodborne illnesses associated with specific sources.
Statement:
By December 31, 2015, reduce the annual adult combustible tobacco consumption in the United States from 1,342 cigarette equivalents per capita to 1,174 cigarette equivalents per capita, which will represent an approximate 12% decrease from the 2012 baseline.
Description:
Smoking and second hand smoke is the leading preventable cause of death in the United States, killing more than an estimated 480,000 people in the U.S. each year. For every smoker who dies from a smoking-attributable disease, another 30 live with a serious smoking-related disease. Smoking costs the U.S. more than $300 billion a year, including nearly $170 billion in direct medical costs, and more than $156 billion in lost productivity. An estimated 58 million nonsmoking Americans are exposed to secondhand smoke, which causes more than 41,000 deaths in non-smoking adults each year . While smoking among U.S. adults is down significantly from a decade ago, the decline in adult smoking rates has slowed, concurrent with reductions in state investments in tobacco control program. Fortunately, people who stop smoking greatly reduce their risk for disease and premature death. Smoking cessation lowers the risk for lung and other types of cancer; it reduces the risk for coronary heart disease, stroke, and peripheral vascular disease. .
In 2010, HHS issued Ending the Epidemic – A Tobacco Control Strategic Action Plan, outlining a set of comprehensive actions framed around four key Healthy People 2020 tobacco control objectives:
1) reduce tobacco use
2) reduce the initiation of tobacco use
3) increase successful cessation attempts by smokers
4) reduce the proportion of nonsmokers exposed to secondhand smoke.
The National Prevention Strategy, released in 2011, includes tobacco control as one of seven priorities across the U.S. Government.
In 2012, cigarette and smokeless tobacco companies spent more than $9.6 billion, more than $1 million per hour that year, on advertising and promotional expenses in the United States to attract new users, retain current users, increase consumption, and generate favorable attitudes toward smoking. There is also a growing concern regarding new tobacco products that are being marketed to smokers as alternatives for use in smoke-free environments. Dual use of cigarettes and other tobacco products can maintain tobacco addiction and use among smokers who might otherwise quit. The marketing of purported reduced-risk products may increase overall tobacco use. Consumer mistaken perceptions of the “safety” of these products may pose a continuing obstacle for tobacco control.
States continue to reduce funding for comprehensive tobacco control. Research has shown that progress to prevent initiation and promote cessation in comprehensive programs is reversed when funding is no longer sustained.
HHS engages with multiple stakeholders in implementing tobacco control activities, which include: Congress, the public, minority communities, groups affected by tobacco-related health disparities, state and local tobacco control officials, tobacco control and public health non-governmental organizations, the scientific & research community, and businesses.
The U.S. Congress has provided direction and support for tobacco control activities in the following legislative actions:
• The Patient Protection and Affordable Care Act
• The American Recovery and Reinvestment Act (ARRA)
• The Family Smoking Prevention and Tobacco Control Act (FSPTCA)
• The Children’s Health Insurance Program Reauthorization Act (CHIPRA)
HHS oversees tobacco control and prevention committees covered by the Federal Advisory Committee Act. All meetings of these committees are open to the public and offer opportunities for stakeholder feedback.
Statement:
To reduce the national rate of healthcare-associated infections (HAIs) by September 30, 2015 by demonstrating a 10% reduction in national hospital-acquired catheter-associated urinary tract infections (CAUTI) from the current SIR of 1.03 to a target SIR of 0.92.
Description:
At any given time, about one in every 25 hospitalized patients has a healthcare-associated infection while over 1 million HAIs occur across the U.S. healthcare system every year. These infections can lead to significant morbidity and mortality, with tens of thousands of lives lost each year.
Of these hospital-acquired events, catheter-associated urinary tract infections (CAUTI) are among the most common. Research has shown that a significant portion of these infections can be prevented, avoiding patient morbidity and mortality from this HAI while reducing costs accrued to the healthcare system.
The HAI Agency Priority Goal is to reduce the national rate of HAI by demonstrating significant, quantitative and measurable reductions in hospital-acquired CAUTI. As such; the FY2014-15 HAI Agency Priority Goal (APG) is to reduce the national CAUTI standardized infection ratio by 10% by September 2015 over the current 2012 baseline of 1.03. Of note, this SIR baseline was changed from 1.02 to 1.03 in this goal. This reflects the fact that the CDC released preliminary final numbers for 2012 in September 2013, the time at which this goal was written. However, hospitals still had through the end of the year to report final data to NHSN. Accounting for the last three months of data submitted by some hospitals caused a slight adjustment in the final (and thus baseline) 2012 SIR from 1.02 to 1.03. We make this adjustment in the HAI.APG to reflect the finalized SIR and to maintain consistency with other HAI reports moving forward.
As we carry this portion of the goal from the FY2011-13 goal, a concerted effort between the Centers for Medicare and Medicaid Services (CMS), Agency for Healthcare Research and Quality (AHRQ), Centers for Disease Control and Prevention (CDC), and Office of the Assistant Secretary of Health (OASH) will continue to be a crucial to meeting goal targets. The main US Department of Health and Human Services (HHS) operating divisions that constitute this workgroup will focus on applying their HAI programmatic efforts in a way that aligns strategy and metrics, provides consistent messaging to its audience, uses data to target those facilities in most need of improvement, and creates synergy to achieve CAUTI reduction outcomes.
We will continue to use combined HHS programmatic levers to contribute to the achievement of CAUTI targets. These initiatives include:
- Quality Improvement Organization (QIOs) Program
- Hospital Inpatient Quality Reporting (HIQR) Program
- Disseminating Data for Action using the National Healthcare Safety Network (NHSN)
- State HAI programs
- Partnership for Patients (PfP)
- Comprehensive Unit-based Safety Program (CUSP) for CAUTI Ongoing coordination through HAI strategic planning, HAI Regional and National Meetings
- Regular review and updates to the National Action Plan to prevent HAIs: "Roadmap to Elimination."
Attention to several factors are necessary to assess progress toward goals in this new period. As in the previous HAI goal and consistent with a measurement strategy used by a majority of hospitals that participate in national HAI reporting initiatives, this goal will use the standardized infection ratio (SIR) as the measure, NHSN, the CDC-run infection surveillance system as the primary data source and report data points on a biannual basis. A six month lag in data will remain in order to ensure the most complete and accurate data being reported out and minimize statistically insignificant variations in the data.
Lessons learned from the previous goal allow us to predict potential changes in the CAUTI SIR trend in the months following January 2015 now that CMS' Hospital Inpatient Quality Reporting (HIQR) program requires participating hospitals to report CAUTI in non-intensive care units to receive their full annual payment update. The influx of new CAUTI reporters in the middle of the previous 2011-13 HAI.APG was identified as one but not the sole, etiology behind an increase in the CAUTI SIR over the life of this goal. The differences in CAUTI SIRs in ICU and non-ICU settings along with the influx of new reporters among non-ICU locations in 2015 may impact this goal. The degree to which this could again be a factor again is unknown especially since through programmatic outreach, many hospitals already report non-ICU CAUTI data to NHSN voluntarily.
We also anticipate application of the new CAUTI definition, which went into effect January 1, 2015, to the APG data we will report in subsequent quarters. Because our baseline CAUTI SIR was calculated using the old CAUTI definition, a strategy to ensure continuity and validity of new SIR data across this goal has been established. The CDC will construct a new SIR by applying the new CAUTI definition to our current baseline SIR and data points proceeding January 1, 2015. In other words, we will translate SIR data including our baseline data prior to January 1st to SIR data that is reflective of the changes in the CAUTI definition. We will also be able to illustrate the CAUTI SIR baseline and trending data by applying the new vs the old definition in order to demonstrate the degree of difference or lack thereof resulting from this definitional change. CDC has changed the CAUTI definition in response to input from stakeholders and scientific data.The HAI Workgroup will present full details on the definition change in relation to this goal and our targeted CAUTI SIR reductions to HHS leadership in November of 2015.
Lastly, analysis of the CAUTI data continues to reveal marked difference in reductions between intensive care and non-intensive care units. Intensive care units have significantly higher SIRs, higher number of catheter-days, and show less reductions in these indicators of progress than in the non ICU setting. The difference in CAUTI reductions between ICUs and non-ICU settings have been highlighted in analysis of both NHSN and CUSP for CAUTI data. Given the fact that sicker patients are admitted in ICUs, retaining a urinary catheter for longer may be a rooted in practice necessity or provider belief that it is a necessity and so concentrating on behavioral and systems process change may need to be further emphasized as we work in this setting to reduce CAUTI. The 10% goal for CAUTI reduction in this APG effort represents a composite goal that reflects greater reductions in non-ICU settings and lesser reductions in ICUs. Improvements in CAUTI however, have been demonstrated in large scale improvement programs when actively engaged in embedding evidence-based infection control protocol and a culture of safety unit and facility-wide. It’s also important to note that preliminary projections through the first three quarters of 2015 continue to show a fall in the CAUTI SIR and an on-track trajectory for achieving the CAUTI goal target.
Statement:
By September 30, 2015, improve the quality of early childhood programs for low-income children through implementation of the Quality Rating and Improvement Systems in the Child Care and Development Fund, and through implementation of the Classroom Assessment Scoring System in Head Start.
Description:
This Priority Goal calls for actions in FY 2014 and FY 2015 to improve the quality of early childhood education programs for low-income children. For the ACF Child Care program, the goal is to increase the number of states with Quality Rating and Improvement Systems (QRIS) that meet the seven high quality benchmarks for child care and other early childhood programs, developed by HHS. QRIS is a mechanism by which to improve the quality of child care available in communities and increase parents’ knowledge and understanding of the child care options available to them. In order for a QRIS to be considered as meeting high-quality benchmarks, it must 1) be statewide; 2) be eligible to child care centers and family child care homes; 3) include quality improvement indicators that cover learning environments and curriculum, teacher/practitioner standards, and family partnerships and strengthening; 4) use training or on-site consultation to help child care programs attain or maintain quality improvement standards beyond licensing; 5) offer financial incentives for maintaining or increasing quality to child care centers and family child care homes; 6) include quality assessments of child care centers and family child care homes; and 7) use symbols or simple icons that indicate levels of quality as part of resource and referral/consumer education services to parents seeking child care. For FY 2011, a baseline of 17 states had implemented a QRIS that met all outlined high quality benchmarks. The baseline was calculated using FY 2012-2013 State Plans that were submitted in September 2011. In FY 2014, 29 states had a QRIS that met high quality benchmarks, meeting the previously established target. States expanded from pilot programs to statewide-systems and increased availability to quality information, leading them to meet more components of the QRIS measure. States were also supported by targeted technical assistance through state specific benchmarks and goals. The FY 2014 results show that states continue to make progress toward implementing QRIS that meet high-quality benchmarks, and the ACF Office of Child Care (OCC) has established a target of 32 states for FY 2015.
Currently, many states meet some, but not all seven, of the outlined benchmarks. States are making significant progress toward implementing a comprehensive QRIS that meets all outlined quality benchmarks; however, their progress is masked by the single figure reported. To provide a more complete picture of QRIS implementation and improvements across the country, OCC is closely tracking the progress of states that may not meet all quality benchmarks, but that have demonstrated improvements by increasing the number of benchmarks reached. For example, as of FY 2014, at least six states have incorporated six quality benchmarks and at least six states have incorporated five quality benchmarks. Between FY 2011 and FY 2014, 27 states and territories have made progress on at least one of the components of the measure. In addition, targeted technical assistance provided by the new National Center on Early Childhood Quality Assurance, as well as other technical assistance partners funded by ACF, will continue to help states work toward their goal of improving their QRIS.
Also as part of this Priority Goal, the ACF Office of Head Start (OHS) is striving to increase the percentage of Head Start children in high quality classrooms. Progress is measured by reducing the proportion of Head Start grantees scoring in the low range in any domain of the Classroom Assessment Scoring System (CLASS: Pre-K). This research-based tool measures teacher-child interaction on a seven-point scale in three broad domains: Emotional Support, Classroom Organization, and Instructional Support. OHS successfully began data collection using random samples for the CLASS: Pre-K in the first quarter of FY 2012. Analysis of the full data set of CLASS scores for the cohort of 388 Head Start grantees that received on-site monitoring in the 2011-2012 Head Start “school year” occurred in October of 2012, and OHS established a baseline of 25 percent scoring in the low range.
An analysis of CLASS scores for the most recent cohort of 404 Head Start grantees that received on-site monitoring in the 2013-2014 Head Start “school year” (FY 2014 actual result) indicates that 23 percent of grantees scored in the low range, thus meeting the target of 27 percent. All grantees scoring in the low range (below 2.5) in FY 2014 did so for the Instructional Support domain. (Nationwide for the CLASS: Pre-K tool, scores are typically higher in the domains of Emotional Support and Classroom Organization than in the domain of Instructional Support.)
The FY 2014 result is a signicant improvement relative to the previous FY 2013 result, when the number of grantees scoring below a 2.5 was 31 percent. In response to the data from the FY 2013 CLASS reviews, OHS developed a system to provide more intentional targeted assistance to those grantees that score in the low range on CLASS. OHS is continuing to flag grantees that score in the low range, conduct more analyses on the specific dimension level, which are specific elements or skill areas within each of the three domains, and providing periodic reports to its Regional Offices so they can direct their TTA to specific grantees. For example, concept development, quality of feedback, and language modeling are the three dimensions within the domain of Instructional Support. Providing TTA at the more specific dimension-level supports grantees to focus in on the skills that need improvement.
There are some challenges to making progress in these areas. In the past two decades, a growing body of evidence has established the importance of quality child care in promoting healthy child development and school readiness and success for children. However, systemic changes take time to implement, and states are at different starting points. In the FY 2016 Budget request to Congress, the President continued to build a continuum of high-quality early childhood programs, including proposing an historic investment of $82 billion over 10 years to increase the availability of high-quality child care for children under four years old. On November 19, 2014, the President signed into the law the first statutory reauthorization of the Child Care and Development Block Grant (CCDBG) program since 1996, which aims to move children receiving subsidies into high-quality child care settings. Among a comprehensive array of reforms, the new statute includes an increased focus on improving the quality of child care through systemic quality investments, which will help move states toward meeting this priority performance goal. In addition, the statute includes provisions requiring states to evaluate the measurable outcomes of their quality improvement activities. OCC is gathering information about QRIS implementation through the CCDBG Plan and the annual quality performance report, as well as providing states with targeted technical assistance through state specific technical assistance plans and goals. ACF recently announced the Early Childhood Training and Technical Assistance System, which transforms the current TA system for child care, T/TA for Head Start, and related programs into a coordinated system that will provide training, resources and materials to multiple stakeholder groups at regional, state and local levels to support school readiness. The new National Center on Early Childhood Quality Assurance will help OCC continue to support the infrastructure of an early childhood education quality improvement framework, including QRIS.
Additionally, with respect to Head Start, there are 50,000 Head Start and Early Head Start classrooms across the country in diverse settings ranging from New York City to the bottom of the Grand Canyon. Changing teacher behavior and practices at the ground level to improve the quality of the classroom is a formidable challenge, particularly in highly rural areas, American Indian and Alaska Native programs, and Migrant and Seasonal Head Start programs where finding qualified staff can be difficult due to more limited access to higher education. OHS is using multiple approaches to address this challenge, including policy levers, training and technical assistance, and professional development efforts.
Strategic Goal:
Ensure Efficiency, Transparency, Accountability, and Effectiveness of HHS Programs
Statement:
Ensure Efficiency, Transparency, Accountability, and Effectiveness of HHS Programs
Strategic Objectives
Statement:
Strengthen program integrity and responsible stewardship by reducing improper payments, fighting fraud, and integrating financial, performance, and risk management
Description:
HHS is working to improve program efficiency and effectiveness, using internal controls and risk assessment activities to strengthen the integrity and accountability of payments.
Statement:
Enhance access to and use of data to improve HHS programs and support improvements in the health and well-being of the American people
Description:
HHS leverages its data in many ways, including working to publish Government information online in ways that are easily accessible and usable; developing and disseminating accurate, high-quality, and timely information; fostering the public’s use of the information HHS provides; and advancing a culture of data sharing at HHS.
Statement:
Invest in the HHS workforce to help meet America’s health and human service needs
Description:
HHS is engaging in a variety of activities to strengthen its human capital and to address challenges in recruitment and retention with a specific emphasis on workforce diversity and succession planning. HHS is focusing on human capital development to inspire innovative approaches to training, recruitment, retention, and ongoing development of Federal workers. Combined with a focus on opportunities to align multiple training programs supported by HHS, the Department will enhance its capacity to address current and emerging challenges.
Statement:
Improve HHS environmental, energy, and economic performance to promote sustainability
Description:
HHS is working to reduce energy consumption and control greenhouse gas emissions; conserve resources through sustainable purchasing, operations, and waste management; and protect human and environmental health through sustainability planning and operations.
Expand All
FY16-17 Agency Priority Goals
An Agency Priority Goal is a near-term result or achievement that agency leadership wants to accomplish within approximately 24 months that relies predominantly on agency implementation as opposed to budget or legislative accomplishments. Click below to see this agency's FY16-17 Priority Goals.
Agency Priority Goal:
Statement:
A critical step toward better care, smarter spending, and healthier people is to use payment incentives to motivate higher-value care by increasingly tying payment to alternative payment models that reward value over volume. To this end, the Secretary has identified the following high priority indicator for managing and tracking progress:
- By December 31, 2017, increase the percentage of Medicare Fee-for-Service (FFS) payments tied to quality and value through alternative payment models (APMs) to 40 percent
Description:
Many health care providers today receive a payment for each individual service, such as a physician visit, surgery, or blood test, regardless of whether these services help or harm the patient. In other words, many providers are paid based on the volume of care, rather than the value of care provided to patients.
To build a health care system that delivers better care, that is smarter about how dollars are spent, and that makes people healthier, the Affordable Care Act (ACA) created a number of new programs and payment models that move the needle toward rewarding value and quality. These models include Accountable Care Organization (ACO) models, medical home models focused on primary care, and new models of bundling payments for episodes of care. In these alternative payment models (APMs), health care providers are accountable for the quality and cost of the care they deliver to patients and have a financial incentive to coordinate care for their patients who are therefore more likely to receive high quality, team-based care.
In 2011, Medicare made almost no payments to providers through alternative payment models, but by the end of 2014 such payments represented approximately 20 percent of Medicare payments. These APMs and payment reforms that increasingly tie Medicare payments to quality and value are currently moving the health care system in the right direction, and increased alignment across payers and providers would be even more beneficial. When health systems, practices, and clinicians encounter new payment strategies for one payer, but not others, the incentives to fundamentally change their system are weak. In the past, there was no common timeline among payers or providers for moving the health care system away from volume based payments. Therefore, for the first time in the history of the program HHS has set an explicit goal for tying Medicare payments to APMs that reward quality and value over volume.
Agency Priority Goal:
Improve the quality of early childhood programs for low-income children
Statement:
Improve the quality of early childhood programs for low-income children. By September 30, 2017, HHS will improve the quality of early childhood programs for low-income children by increasing the number of states with Quality Rating and Improvement Systems (QRIS) that meet high quality benchmarks from a baseline of 17 states in FY 2011 to 37 states in FY 2017, reducing the proportion of grantees receiving a score in the low range on the basis of the Classroom Assessment Scoring System (CLASS) from a baseline of 25 percent (FY 2012) to 24 percent in FY 2017, and increasing the percent of teachers in Head Start and Early Head Start that have a BA or higher by 2 percentage points each year from a baseline of 52 percent (FY 2012).
Description:
This area of work has been a Priority Goal for each of the previous Priority Goal iterations. Previously the work was limited to the Administration for Children and Families (ACF) programs; HHS intends to keep the same overarching Priority Goal, with its emphasis on improving quality, but add a second Key Indicator for ACF’s Head Start program focused on increasing the percent of teachers with a BA. In addition, HHS will expand the contributing programs to include information regarding partnerships with the Substance Abuse and Mental Health Administration (SAMHSA) and the Health Resources and Services Administration (HRSA) to demonstrate that this Priority Goal represents an overarching Departmental priority.
This Priority Goal reflects HHS’ efforts to enhance the quality of early childhood education for low-income children. All three key measures provide unique and important aspects of boosting the quality of early childhood programs and services.
Head Start is the largest early learning funding stream, serving about 1 million low-income children and their families each year. The two key measures for Head Start address the quality of instructional practice in the classroom using Classroom Assessment Scoring System (CLASS) scores and workforce qualifications through BA degrees. Reducing the percent of Head Start grantees scoring in the low range on the three CLASS measures is key to our effort to improve the overall quality of instructional practice in Head Start. A key way to achieve this is ensuring that our teachers have evidence-based knowledge, skills, and practice. By emphasizing the credentials of teachers, and striving to increase the percent of Head Start and Early Head Start teachers with a BA degree, ACF is prioritizing a distinct but complementary goal in boosting the quality of Head Start programs. A challenge is the availability of resources to ensure BA teachers are paid commensurate with their qualifications.
The third key measure assesses state Quality Rating and Improvement Systems (QRIS), which is another important aspect of quality, but rather than providing information at the individual program level, this indicator gets at quality at the state systems level. QRIS is a system used by states to improve the quality of child care available in communities and increase parents’ knowledge and understanding of the child care options available to them. QRIS supports child care providers through professional development and training as well as financial incentives; help increase parental choice by improving the overall quality of early care and education across a range of settings, giving parents more high-quality child care options; and lead to more low-income children in higher quality child care settings. QRIS across the country have been heavily funded by ACF's Child Care and Development Fund (CCDF) and CCDF technical assistance funding, and support has played a key role in helping states to design, implement, evaluate, and improve their QRIS. By creating and investing significant resources in QRIS, states have recognized QRIS as a systemic approach for promoting quality of early childhood and afterschool programs, and it is important to track the development and implementation of QRIS across the country.
In order for a QRIS to be considered as meeting high-quality benchmarks, it must 1) be statewide; 2) be eligible to child care centers and family child care homes; 3) include quality improvement indicators that cover learning environments and curriculum, teacher/practitioner standards, and family partnerships and strengthening; 4) use training or on-site consultation to help child care programs attain or maintain quality improvement standards beyond licensing; 5) offer financial incentives for maintaining or increasing quality to child care centers and family child care homes; 6) include quality assessments of child care centers and family child care homes; and 7) use symbols or simple icons that indicate levels of quality as part of resource and referral/consumer education services to parents seeking child care. More than half the states have implemented QRIS open to child care providers across the state, and the majority of the remaining states are piloting or planning QRIS. However, not all states have a QRIS that meets high-quality benchmarks and systemic changes take time to implement.
This goal supports HHS Strategic Goal 3: Advance the Health, Safety, and Well-Being of the American People, in particular Objective A (Promote the safety, well-being, resilience, and healthy development of children and youth.) and Objective B (Promote economic and social well-being for individuals, families, and communities). The new proposed key measure from ACF’s Office of Head Start (OHS) regarding teacher credentialing supports HHS Strategic Plan Goal 4 (Ensure Efficiency, Transparency, Accountability, and Effectiveness of HHS Programs.) Objective C: Invest in the HHS workforce to help meet America’s health and human services needs. This Priority Goal also supports three ACF Strategic Goals – to “Promote economic, health, and social well-being for individuals, families, and communities;” “Promote healthy development and school readiness for children, especially those in low-income families;” and “Promote safety and well-being of children, youth, and families.”
Agency Priority Goal:
Improve the timeliness of initiation into treatment for individuals with serious mental illness.
Statement:
Improve the timeliness of initiation into treatment for individuals with serious mental illness. By September 30, 2017, expand the availability of evidence-based early intervention services for individuals with serious mental illness (SMI) funded through the Substance Abuse and Mental Health Services Administration (SAMHSA) Community Mental Health Services Block Grant by increasing the number of states with at least one evidence-based early intervention program that provides a team-based approach to treatment including services such as case management, recovery-oriented cognitive and behavioral skills training, supported employment, supported education services, family education and support, and low doses of medications when indicated. The goal is to increase by 130 percent from a baseline of 13 states in 2015.
Description:
Serious mental illnesses often first arise in adolescence or early adulthood, and delays in treatment initiation are common. As a result, people with serious mental illness (SMI) may experience multiple episodes of acute illness accompanied by accumulating disability. The National Institute of Mental Health (NIMH) at the National Institutes of Health (NIH) estimates that the direct and indirect financial costs of serious mental illness—including health expenditures, disability benefits, and loss of earnings—exceed $300 billion per year in the United States.
Individuals with serious mental illness (SMI) are a high-need, high-cost population. They are frequent utilizers of emergency departments and have high rates of readmission to inpatient care, especially when co-occurring substance use disorders are present. In addition, people with SMI often have co-morbid physical health conditions and shorter life expectancies than people without SMI, primarily due to co-occurring physical health conditions that too often go unaddressed.
Individuals with serious mental illness (SMI) often experience barriers to treatment, including difficulty accessing and initiating treatment. Significant delays in the identification and treatment of SMI are common; for example, research has repeatedly found that individuals with psychosis in the U.S. often do not receive appropriate treatment for that condition for one to three years. Moreover, once they do receive care, individuals with serious mental illness might not receive evidence-based care, or care that is coordinated with medical care. There is a growing body of evidence highlighting the effectiveness of early intervention using evidence-based treatments to improve outcomes for individuals with SMI, including psychotherapy and education and employment supports. The use of peer supports is another promising practice with a growing evidence base.
Challenges that prevent the dissemination of these best practices in the provision of early intervention services include lack of funding, the need for technical assistance, the need to educate and engage consumers, and the need to further build the evidence base supporting the provision of early intervention services. These challenges impact the ability of states to establish and maintain early intervention programs using Community Mental Health Services Block Grant funding.
The SMI Initiative builds on activities that are currently underway in various HHS agencies; these activities are coordinated through the HHS Behavioral Health Coordinating Council (BHCC). The BHCC subcommittee on SMI is critical to the implementation of the Initiative, which is also oriented towards achievement of this Agency Priority Goal on SMI.
Agency Priority Goal:
Statement:
Combat antibiotic-resistant bacteria to save lives. By September 30, 2017, HHS will increase the percent of hospitals that report implementation of antibiotic stewardship programs that comply with all of the CDC Core Elements for Hospital Antibiotic Stewardship Programs by 50% from a baseline of 40.9% to 61.3%.
Description:
Antibiotics have been a critical public health tool since the discovery of penicillin in 1928, saving the lives of millions of people around the world. Today, however, the emergence of drug resistance in bacteria is reversing the miracles of the past eighty years, with drug choices for the treatment of many bacterial infections becoming increasingly limited, expensive, and, in some cases, nonexistent. The Centers for Disease Control and Prevention (CDC) estimates that drug-resistant bacteria cause two million illnesses and approximately 23,000 deaths each year in the United States alone. Thus, combatting antibiotic resistance has become a priority for both the White House, and the Department of Health Human Services (DHHS) Secretary. In response to President Barack Obama’s Executive Order: Combating Antibiotic-Resistant Bacteria (CARB), the National Strategy and the National Action Plan for CARB were developed to provide a roadmap to guide the Nation in rising to this challenge. One of the core strategies within the action plan is improving the use of antibiotics, also known as antibiotic stewardship. This Agency Priority Goal (APG) will help advance efforts related to antibiotic stewardship in hospitals, where complications of and risk factors for antibiotic resistance are most concentrated. The APG also aligns with the strategic goals listed in the 2014-2018 HHS Strategic Plan.
Current Problem/Challenges:
At least one-third of antibiotics used in inpatient settings are either unnecessary or inappropriately prescribed. Antibiotic stewardship interventions have been proven to improve individual patient outcomes, reduce the overall burden of antibiotic resistance, and save healthcare dollars. Implementation of antibiotic stewardship programs in hospitals will help ensure that hospitalized patients receive the right antibiotic, at the right dose, at the right time, and for the right duration. Improved antibiotic use leads to reduced mortality, reduced risk of Clostridium difficile-associated diarrhea, shorter hospital stays, reduced overall antibiotic resistance within the hospital, and increased cost savings. Despite all of these benefits, the uptake of antibiotic stewardship programs and interventions among U.S. hospitals is variable. Data from 2014 show that only about 40% of US acute care hospitals report having antibiotic stewardship programs that incorporate all of the CDC Core Elements for Hospital Antibiotic Stewardship Programs.
Agency Priority Goal:
Statement:
To reduce opioid-related morbidity and mortality: By September 30th, 2017, opioid-related overdose death and opioid use disorder will be addressed through the three priority areas of reforming opioid prescribing practices, increasing the use of naloxone, and expanding access to and use of MAT for opioid use disorders.
- Decrease by 10% the total morphine milligram equivalents (MME) dispensed in the U.S. outpatient retail pharmacy setting.
- Increase by 15% the number of prescriptions dispensed for naloxone in the U.S. outpatient retail pharmacy setting
- Increase by 10% the number of unique patients receiving prescriptions for buprenorphine and naltrexone in the U.S. outpatient retail pharmacy setting.
Description:
Opioid abuse and overdose present a nationwide public health challenge. Death by drug overdose is the leading cause of injury death in the United States, with deaths from opioids in particular increasing precipitously in the twenty-first century. Overdose deaths from prescription opioids, such as oxycodone, hydrocodone, and morphine, have more than quadrupled over the period 1999-2013. Overdose deaths involving heroin have increased significantly in recent years, more than tripling from 2010-20141. Agencies across HHS recognize the urgency of halting the rise of opioid use disorder and overdose, and are working to develop and implement the most effective interventions, from prevention through treatment.
In March of 2015, HHS Secretary Burwell introduced the Secretary’s Opioid Initiative to accelerate progress toward two broad goals: 1) decreasing opioid overdoses and overall overdose mortality and 2) decreasing the prevalence of opioid use disorder. This unifying strategy is designed to focus implementation efforts on action steps most likely to yield rapid and meaningful results. Specifically, the Initiative focuses on the three areas of reforming of opioid prescribing practices to reduce excess prescribing; improving naloxone development, access, and distribution; and expanding access to medication-assisted treatment (MAT). This Agency Priority Goal (APG) and accompanying metrics align with the three emphasis areas of the Initiative. Further, this opioid APG represents targeted assessment of the near-term progress that will be essential for achieving the broader Initiative goals of overall reduction in the morbidity and mortality associated with opioid use.
Agency Priority Goal:
Statement:
By December 31, 2017, working with federal, state, local, tribal, and industry partners, improve preventive controls in food production facilities and reduce the incidence rate (reported cases per 100,000 population per year) of Listeria monocytogenes (L.m.) infections by 8%.
Description:
With enactment of the 2011 Food Safety Modernization Act (FSMA) Congress mandated a paradigm shift to prevention – to establishing a modern system of food safety protection based not on reacting to problems but on preventing them from happening in the first place. FSMA has stimulated fundamental changes in FDA’s approach with establishment of preventive controls food safety standards. Key components of our implementation strategy include providing technical guidance and assistance to the industry, reorienting food safety staff to work in new ways, and improving surveillance of the food supply chain, so we can provide consistent, high quality oversight within the more technically sophisticated FSMA framework and better detect food safety problems when they occur. While prevention is the focus, food contamination events do occur.
Listeria monocytogenes (L.m.) infections are one of the leading causes of death from foodborne illness in the United States, resulting in an estimated 1,600 illnesses and 260 deaths each year. Outbreak investigations determine which foods are responsible for illness and can lead to important food safety improvements. For example, recent investigations identified previously unknown sources of L.m. illnesses—cantaloupe, ice cream, and caramel apples—and focused attention on preventing contamination of these products. However, finding the source of clusters of L.m. illnesses is difficult. Determining if the same strain of L.m is making people sick, meaning the illnesses likely came from the same food source, requires intensive investigation. Clusters of illnesses caused by L.m. strains with the same genetic fingerprint are often small. Figuring out what ill persons ate in common is often very difficult; especially when some are too sick for interviews or have died and the long incubation period makes it more difficult for patients to remember what and where they ate. More complete information from patient interviews, information about isolations of L.m. from food and the environment, and whole genome sequencing of strains can all help to detect outbreaks and identify their sources. When food sources and the cause of contamination are identified, food safety changes can be implemented throughout an industry and prevent future outbreaks.
Tracing foods to the source of contamination and determining how the contamination occurred is challenging. Ready-to-eat (RTE) foods can be contaminated if ingredients in the foods are contaminated with L.m. and are not treated to destroy viable cells of this pathogen, or if L.m. is allowed to contaminate the RTE food because of improper sanitary conditions or practices. For many RTE foods, contamination with L.m. can be avoided – e.g., through the application of current good manufacturing practices and sanitation. Sanitation controls include effective environmental monitoring programs designed to identify and eliminate L.m. in and on surfaces and areas in production and processing facility. As we learn from L.m. illness investigations and implement the preventive controls regulations, FDA will work with our food safety partners to better characterize the risks of L.m. contamination and provide guidance on how to better evaluate the hazards in food production and processing operations, and implement and monitor effective measures to prevent contamination.
As part of a shared vision to reduce foodborne L.m. illnesses, HHS’s Food and Drug Administration (FDA), the Centers for Disease Control and Prevention (CDC), and the United States Department of Agriculture’s Food Safety and Inspection Service (USDA-FSIS) have undertaken several activities to realize this vision. FDA recently released new preventive controls standards and is now working to increase industry’s application of preventive controls for L.m. hazards. FDA, CDC, National Institute of Health (NIH), and USDA-FSIS are collaborating to use genomic methods to help determine the food source of outbreaks and to determine the sources of L.m. in the food supply chain. Whole genome sequencing (WGS), combined with robust data from epidemiologic investigations, has the potential to greatly improve the detection and investigation of L.m. outbreaks and can even help link single, sporadic illnesses to foods, something rarely possible before. FDA and USDA-FSIS share regulatory responsibility for preventing L.m. contamination in food and as such will jointly report on their array of activities to reduce L.m. contamination at various points across the food supply chain. Collectively, these activities should help to reduce the overall burden of listeriosis in the population.
Findings from these efforts will ultimately advance the work of the Interagency Food Safety Analytics Collaboration, a tri-agency group of FDA, CDC, and USDA-FSIS, that is combining data from outbreaks with other information to determine the major sources of L.m. illness. The results of this work will significantly contribute to FDA’s and USDA-FSIS’s efforts in implementing more risk-informed food safety strategies and to better target resource allocations.
This Agency Priority Goal supports HHS Strategic Plan Goal 3, Objective E to reduce the occurrence of infectious disease and the Healthy People 2020 goal to reduce the incidence of L.m. infections. It also supports FDA Strategic Priorities, Goal 1, Enhance Oversight of FDA-Regulated Products and all the corresponding Objectives. Improving food safety is one of the CDC Director’s designated “Winnable Battles.” The indicator to strengthen collection of patient interview and laboratory data is consistent with a Quarterly Progress Report target for the CDC Director. And while FSIS does not fall under HHS, it is important to mention that this HHS Agency Priority Goal aligns with an outcome under USDA’s Strategic Goal 4 - to reduce the total number of Salmonella, L.m. and E.coli illnesses from USDA-FSIS regulated products and to FSIS’s Strategic Goal of preventing foodborne illness and protecting the public’s health.
Agency Priority Goal:
Reduce the annual adult combustible tobacco consumption in the United States.
Statement:
By December 31, 2017, reduce the annual adult combustible tobacco consumption in the United States from 1,216 cigarette equivalents per capita to 1,127 cigarette equivalents per capita, which will represent an approximate 7% decrease from the 2014 baseline.
Description:
Smoking and second hand smoke is the leading preventable cause of death in the United States, killing more than an estimated 480,000 people in the U.S. each year. For every smoker who dies from a smoking-attributable disease, another 30 live with a serious smoking-related disease. Smoking costs the U.S. more than $300 billion a year, including nearly $170 billion in direct medical costs, and more than $156 billion in lost productivity. An estimated 58 million nonsmoking Americans are exposed to secondhand smoke, which causes more than 41,000 deaths in non-smoking adults each year[1]. While cigarette smoking among adults has declined significantly over the past several decades, the use of other tobacco products has increased or stayed the same in recent years, concurrent with reductions in state investments in tobacco control program. Fortunately, people who stop smoking greatly reduce their risk for disease and premature death. Smoking cessation lowers the risk for lung and other types of cancer; it reduces the risk for coronary heart disease, stroke, and peripheral vascular disease. .
For FY15, the annual per capita adult cigarette consumption fell to 1,211 cigarette equivalents a 4% reduction from FY 14, but missing the target of 1,174 (37 cigarette equivalents). However, the FY14 results (the most recent available data) of other combustible tobacco use indicators are tracking lower usage across both adults and youth:
- Percentage of adult smokers - 16.8%; exceeding the FY14 target of 18% (National Health Interview Survey)
- Percentage of adult smokers last smoked 6 months to 1 year ago – 7.6%; exceeding the FY14 target of 7.2% (National Health Interview Survey)
- Percentage of children/adolescents initiation – 3.8%; exceeding the FY14 target of 4.7% (National Survey on Drug Use and Health)
- Percentage of young adults initiation – 7.2%; exceeding the FY14 target of 7.5% (National Survey on Drug Use and Health)
These significant trends with the continued plans of the Department to address combustible tobacco use make the FY16-FY17 combustible tobacco Agency Priority Goal highly achievable.
In 2010, HHS issued Ending the Epidemic – A Tobacco Control Strategic Action Plan, outlining a set of comprehensive actions framed around four key Healthy People 2020 tobacco control objectives:
- reduce tobacco use
- reduce the initiation of tobacco use
- increase successful cessation attempts by smokers
- reduce the proportion of nonsmokers exposed to secondhand smoke.
The National Prevention Strategy, released in 2011, includes tobacco control as one of seven priorities across the U.S. Government.
In 2013, cigarette and smokeless tobacco companies spent more than $9.5 billion, more than $1 million per hour that year, on advertising and promotional expenses in the United States to attract new users, retain current users, increase consumption, and generate favorable attitudes toward smoking. There is also a growing concern regarding new tobacco products that are being marketed to smokers as alternatives for use in smoke-free environments. Dual use of cigarettes and other tobacco products can maintain tobacco addiction and use among smokers who might otherwise quit. The marketing of purported reduced-risk products may increase overall tobacco use. Consumer mistaken perceptions of the “safety” of these products may pose a continuing obstacle for tobacco control.
States continue to reduce funding for comprehensive tobacco control. Research has shown that progress to prevent initiation and promote cessation in comprehensive programs is reversed when funding is no longer sustained.
HHS engages with multiple stakeholders in implementing tobacco control activities, which include: Congress, the public, minority communities, groups affected by tobacco-related health disparities, state and local tobacco control officials, tobacco control and public health non-governmental organizations, the scientific & research community, and businesses.
The U.S. Congress has provided direction and support for tobacco control activities in the following legislative actions:
- The Patient Protection and Affordable Care Act
- The American Recovery and Reinvestment Act (ARRA)
- The Family Smoking Prevention and Tobacco Control Act (FSPTCA)
- The Children’s Health Insurance Program Reauthorization Act (CHIPRA)
HHS oversees tobacco control and prevention committees covered by the Federal Advisory Committee Act. All meetings of these committees are open to the public and offer opportunities for stakeholder feedback.
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FY14-15 Agency Priority Goals
An Agency Priority Goal is a near-term result or achievement that agency leadership wants to accomplish within approximately 24 months that relies predominantly on agency implementation as opposed to budget or legislative accomplishments. Click below to see this agency's FY14-15 Priority Goals.
Agency Priority Goal:
Statement:
By December 31, 2015, decrease the rate of Salmonella Enteritidis illness in the population from 2.6 cases per 100,000 (2007-2009 baseline) to 1.9 cases per 100,000.
Description:
Salmonella is the leading known cause of bacterial foodborne illness and death in the United States. Each year in the United States, Salmonella causes an estimated 1.2 million illnesses, including fever and diarrhea, and between 400 and 500 deaths. Salmonella serotype Enteritidis (SE), a subtype of Salmonella, is now the most common type of Salmonella in the United States and accounts for approximately 20% of all Salmonella cases in humans. The most significant sources of foodborne SE infections are shell eggs (FDA-regulated) and broiler chickens (USDA-regulated). Therefore, reducing SE illness from shell eggs is the most appropriate FDA strategy for reducing illness from SE. Preventing Salmonella infections depends on actions taken by regulatory agencies, the food industry and consumers to reduce contamination of food, as well as actions taken for detecting and responding to outbreaks. As part of the shared vision to reduce foodborne illness, HHS's Food and Drug Administration (FDA) has developed a Priority Goal to reduce Salmonella contamination in shell eggs, and the Centers for Disease Control and Prevention (CDC) is working with FDA to gather more data to better estimate sources of illness. Additionally, USDA, FDA and CDC are involved in many interagency efforts, including the Interagency Food Safety Analytics Collaboration (IFSAC). This interagency collaboration is working to improve methods used to estimate the proportion of foodborne illnesses associated with specific sources.
Agency Priority Goal:
Statement:
By December 31, 2015, reduce the annual adult combustible tobacco consumption in the United States from 1,342 cigarette equivalents per capita to 1,174 cigarette equivalents per capita, which will represent an approximate 12% decrease from the 2012 baseline.
Description:
Smoking and second hand smoke is the leading preventable cause of death in the United States, killing more than an estimated 480,000 people in the U.S. each year. For every smoker who dies from a smoking-attributable disease, another 30 live with a serious smoking-related disease. Smoking costs the U.S. more than $300 billion a year, including nearly $170 billion in direct medical costs, and more than $156 billion in lost productivity. An estimated 58 million nonsmoking Americans are exposed to secondhand smoke, which causes more than 41,000 deaths in non-smoking adults each year . While smoking among U.S. adults is down significantly from a decade ago, the decline in adult smoking rates has slowed, concurrent with reductions in state investments in tobacco control program. Fortunately, people who stop smoking greatly reduce their risk for disease and premature death. Smoking cessation lowers the risk for lung and other types of cancer; it reduces the risk for coronary heart disease, stroke, and peripheral vascular disease. .
In 2010, HHS issued Ending the Epidemic – A Tobacco Control Strategic Action Plan, outlining a set of comprehensive actions framed around four key Healthy People 2020 tobacco control objectives:
1) reduce tobacco use
2) reduce the initiation of tobacco use
3) increase successful cessation attempts by smokers
4) reduce the proportion of nonsmokers exposed to secondhand smoke.
The National Prevention Strategy, released in 2011, includes tobacco control as one of seven priorities across the U.S. Government.
In 2012, cigarette and smokeless tobacco companies spent more than $9.6 billion, more than $1 million per hour that year, on advertising and promotional expenses in the United States to attract new users, retain current users, increase consumption, and generate favorable attitudes toward smoking. There is also a growing concern regarding new tobacco products that are being marketed to smokers as alternatives for use in smoke-free environments. Dual use of cigarettes and other tobacco products can maintain tobacco addiction and use among smokers who might otherwise quit. The marketing of purported reduced-risk products may increase overall tobacco use. Consumer mistaken perceptions of the “safety” of these products may pose a continuing obstacle for tobacco control.
States continue to reduce funding for comprehensive tobacco control. Research has shown that progress to prevent initiation and promote cessation in comprehensive programs is reversed when funding is no longer sustained.
HHS engages with multiple stakeholders in implementing tobacco control activities, which include: Congress, the public, minority communities, groups affected by tobacco-related health disparities, state and local tobacco control officials, tobacco control and public health non-governmental organizations, the scientific & research community, and businesses.
The U.S. Congress has provided direction and support for tobacco control activities in the following legislative actions:
• The Patient Protection and Affordable Care Act
• The American Recovery and Reinvestment Act (ARRA)
• The Family Smoking Prevention and Tobacco Control Act (FSPTCA)
• The Children’s Health Insurance Program Reauthorization Act (CHIPRA)
HHS oversees tobacco control and prevention committees covered by the Federal Advisory Committee Act. All meetings of these committees are open to the public and offer opportunities for stakeholder feedback.
Agency Priority Goal:
Statement:
To reduce the national rate of healthcare-associated infections (HAIs) by September 30, 2015 by demonstrating a 10% reduction in national hospital-acquired catheter-associated urinary tract infections (CAUTI) from the current SIR of 1.03 to a target SIR of 0.92.
Description:
At any given time, about one in every 25 hospitalized patients has a healthcare-associated infection while over 1 million HAIs occur across the U.S. healthcare system every year. These infections can lead to significant morbidity and mortality, with tens of thousands of lives lost each year.
Of these hospital-acquired events, catheter-associated urinary tract infections (CAUTI) are among the most common. Research has shown that a significant portion of these infections can be prevented, avoiding patient morbidity and mortality from this HAI while reducing costs accrued to the healthcare system.
The HAI Agency Priority Goal is to reduce the national rate of HAI by demonstrating significant, quantitative and measurable reductions in hospital-acquired CAUTI. As such; the FY2014-15 HAI Agency Priority Goal (APG) is to reduce the national CAUTI standardized infection ratio by 10% by September 2015 over the current 2012 baseline of 1.03. Of note, this SIR baseline was changed from 1.02 to 1.03 in this goal. This reflects the fact that the CDC released preliminary final numbers for 2012 in September 2013, the time at which this goal was written. However, hospitals still had through the end of the year to report final data to NHSN. Accounting for the last three months of data submitted by some hospitals caused a slight adjustment in the final (and thus baseline) 2012 SIR from 1.02 to 1.03. We make this adjustment in the HAI.APG to reflect the finalized SIR and to maintain consistency with other HAI reports moving forward.
As we carry this portion of the goal from the FY2011-13 goal, a concerted effort between the Centers for Medicare and Medicaid Services (CMS), Agency for Healthcare Research and Quality (AHRQ), Centers for Disease Control and Prevention (CDC), and Office of the Assistant Secretary of Health (OASH) will continue to be a crucial to meeting goal targets. The main US Department of Health and Human Services (HHS) operating divisions that constitute this workgroup will focus on applying their HAI programmatic efforts in a way that aligns strategy and metrics, provides consistent messaging to its audience, uses data to target those facilities in most need of improvement, and creates synergy to achieve CAUTI reduction outcomes.
We will continue to use combined HHS programmatic levers to contribute to the achievement of CAUTI targets. These initiatives include:
- Quality Improvement Organization (QIOs) Program
- Hospital Inpatient Quality Reporting (HIQR) Program
- Disseminating Data for Action using the National Healthcare Safety Network (NHSN)
- State HAI programs
- Partnership for Patients (PfP)
- Comprehensive Unit-based Safety Program (CUSP) for CAUTI Ongoing coordination through HAI strategic planning, HAI Regional and National Meetings
- Regular review and updates to the National Action Plan to prevent HAIs: "Roadmap to Elimination."
Attention to several factors are necessary to assess progress toward goals in this new period. As in the previous HAI goal and consistent with a measurement strategy used by a majority of hospitals that participate in national HAI reporting initiatives, this goal will use the standardized infection ratio (SIR) as the measure, NHSN, the CDC-run infection surveillance system as the primary data source and report data points on a biannual basis. A six month lag in data will remain in order to ensure the most complete and accurate data being reported out and minimize statistically insignificant variations in the data.
Lessons learned from the previous goal allow us to predict potential changes in the CAUTI SIR trend in the months following January 2015 now that CMS' Hospital Inpatient Quality Reporting (HIQR) program requires participating hospitals to report CAUTI in non-intensive care units to receive their full annual payment update. The influx of new CAUTI reporters in the middle of the previous 2011-13 HAI.APG was identified as one but not the sole, etiology behind an increase in the CAUTI SIR over the life of this goal. The differences in CAUTI SIRs in ICU and non-ICU settings along with the influx of new reporters among non-ICU locations in 2015 may impact this goal. The degree to which this could again be a factor again is unknown especially since through programmatic outreach, many hospitals already report non-ICU CAUTI data to NHSN voluntarily.
We also anticipate application of the new CAUTI definition, which went into effect January 1, 2015, to the APG data we will report in subsequent quarters. Because our baseline CAUTI SIR was calculated using the old CAUTI definition, a strategy to ensure continuity and validity of new SIR data across this goal has been established. The CDC will construct a new SIR by applying the new CAUTI definition to our current baseline SIR and data points proceeding January 1, 2015. In other words, we will translate SIR data including our baseline data prior to January 1st to SIR data that is reflective of the changes in the CAUTI definition. We will also be able to illustrate the CAUTI SIR baseline and trending data by applying the new vs the old definition in order to demonstrate the degree of difference or lack thereof resulting from this definitional change. CDC has changed the CAUTI definition in response to input from stakeholders and scientific data.The HAI Workgroup will present full details on the definition change in relation to this goal and our targeted CAUTI SIR reductions to HHS leadership in November of 2015.
Lastly, analysis of the CAUTI data continues to reveal marked difference in reductions between intensive care and non-intensive care units. Intensive care units have significantly higher SIRs, higher number of catheter-days, and show less reductions in these indicators of progress than in the non ICU setting. The difference in CAUTI reductions between ICUs and non-ICU settings have been highlighted in analysis of both NHSN and CUSP for CAUTI data. Given the fact that sicker patients are admitted in ICUs, retaining a urinary catheter for longer may be a rooted in practice necessity or provider belief that it is a necessity and so concentrating on behavioral and systems process change may need to be further emphasized as we work in this setting to reduce CAUTI. The 10% goal for CAUTI reduction in this APG effort represents a composite goal that reflects greater reductions in non-ICU settings and lesser reductions in ICUs. Improvements in CAUTI however, have been demonstrated in large scale improvement programs when actively engaged in embedding evidence-based infection control protocol and a culture of safety unit and facility-wide. It’s also important to note that preliminary projections through the first three quarters of 2015 continue to show a fall in the CAUTI SIR and an on-track trajectory for achieving the CAUTI goal target.
Agency Priority Goal:
Statement:
By September 30, 2015, improve the quality of early childhood programs for low-income children through implementation of the Quality Rating and Improvement Systems in the Child Care and Development Fund, and through implementation of the Classroom Assessment Scoring System in Head Start.
Description:
This Priority Goal calls for actions in FY 2014 and FY 2015 to improve the quality of early childhood education programs for low-income children. For the ACF Child Care program, the goal is to increase the number of states with Quality Rating and Improvement Systems (QRIS) that meet the seven high quality benchmarks for child care and other early childhood programs, developed by HHS. QRIS is a mechanism by which to improve the quality of child care available in communities and increase parents’ knowledge and understanding of the child care options available to them. In order for a QRIS to be considered as meeting high-quality benchmarks, it must 1) be statewide; 2) be eligible to child care centers and family child care homes; 3) include quality improvement indicators that cover learning environments and curriculum, teacher/practitioner standards, and family partnerships and strengthening; 4) use training or on-site consultation to help child care programs attain or maintain quality improvement standards beyond licensing; 5) offer financial incentives for maintaining or increasing quality to child care centers and family child care homes; 6) include quality assessments of child care centers and family child care homes; and 7) use symbols or simple icons that indicate levels of quality as part of resource and referral/consumer education services to parents seeking child care. For FY 2011, a baseline of 17 states had implemented a QRIS that met all outlined high quality benchmarks. The baseline was calculated using FY 2012-2013 State Plans that were submitted in September 2011. In FY 2014, 29 states had a QRIS that met high quality benchmarks, meeting the previously established target. States expanded from pilot programs to statewide-systems and increased availability to quality information, leading them to meet more components of the QRIS measure. States were also supported by targeted technical assistance through state specific benchmarks and goals. The FY 2014 results show that states continue to make progress toward implementing QRIS that meet high-quality benchmarks, and the ACF Office of Child Care (OCC) has established a target of 32 states for FY 2015.
Currently, many states meet some, but not all seven, of the outlined benchmarks. States are making significant progress toward implementing a comprehensive QRIS that meets all outlined quality benchmarks; however, their progress is masked by the single figure reported. To provide a more complete picture of QRIS implementation and improvements across the country, OCC is closely tracking the progress of states that may not meet all quality benchmarks, but that have demonstrated improvements by increasing the number of benchmarks reached. For example, as of FY 2014, at least six states have incorporated six quality benchmarks and at least six states have incorporated five quality benchmarks. Between FY 2011 and FY 2014, 27 states and territories have made progress on at least one of the components of the measure. In addition, targeted technical assistance provided by the new National Center on Early Childhood Quality Assurance, as well as other technical assistance partners funded by ACF, will continue to help states work toward their goal of improving their QRIS.
Also as part of this Priority Goal, the ACF Office of Head Start (OHS) is striving to increase the percentage of Head Start children in high quality classrooms. Progress is measured by reducing the proportion of Head Start grantees scoring in the low range in any domain of the Classroom Assessment Scoring System (CLASS: Pre-K). This research-based tool measures teacher-child interaction on a seven-point scale in three broad domains: Emotional Support, Classroom Organization, and Instructional Support. OHS successfully began data collection using random samples for the CLASS: Pre-K in the first quarter of FY 2012. Analysis of the full data set of CLASS scores for the cohort of 388 Head Start grantees that received on-site monitoring in the 2011-2012 Head Start “school year” occurred in October of 2012, and OHS established a baseline of 25 percent scoring in the low range.
An analysis of CLASS scores for the most recent cohort of 404 Head Start grantees that received on-site monitoring in the 2013-2014 Head Start “school year” (FY 2014 actual result) indicates that 23 percent of grantees scored in the low range, thus meeting the target of 27 percent. All grantees scoring in the low range (below 2.5) in FY 2014 did so for the Instructional Support domain. (Nationwide for the CLASS: Pre-K tool, scores are typically higher in the domains of Emotional Support and Classroom Organization than in the domain of Instructional Support.)
The FY 2014 result is a signicant improvement relative to the previous FY 2013 result, when the number of grantees scoring below a 2.5 was 31 percent. In response to the data from the FY 2013 CLASS reviews, OHS developed a system to provide more intentional targeted assistance to those grantees that score in the low range on CLASS. OHS is continuing to flag grantees that score in the low range, conduct more analyses on the specific dimension level, which are specific elements or skill areas within each of the three domains, and providing periodic reports to its Regional Offices so they can direct their TTA to specific grantees. For example, concept development, quality of feedback, and language modeling are the three dimensions within the domain of Instructional Support. Providing TTA at the more specific dimension-level supports grantees to focus in on the skills that need improvement.
There are some challenges to making progress in these areas. In the past two decades, a growing body of evidence has established the importance of quality child care in promoting healthy child development and school readiness and success for children. However, systemic changes take time to implement, and states are at different starting points. In the FY 2016 Budget request to Congress, the President continued to build a continuum of high-quality early childhood programs, including proposing an historic investment of $82 billion over 10 years to increase the availability of high-quality child care for children under four years old. On November 19, 2014, the President signed into the law the first statutory reauthorization of the Child Care and Development Block Grant (CCDBG) program since 1996, which aims to move children receiving subsidies into high-quality child care settings. Among a comprehensive array of reforms, the new statute includes an increased focus on improving the quality of child care through systemic quality investments, which will help move states toward meeting this priority performance goal. In addition, the statute includes provisions requiring states to evaluate the measurable outcomes of their quality improvement activities. OCC is gathering information about QRIS implementation through the CCDBG Plan and the annual quality performance report, as well as providing states with targeted technical assistance through state specific technical assistance plans and goals. ACF recently announced the Early Childhood Training and Technical Assistance System, which transforms the current TA system for child care, T/TA for Head Start, and related programs into a coordinated system that will provide training, resources and materials to multiple stakeholder groups at regional, state and local levels to support school readiness. The new National Center on Early Childhood Quality Assurance will help OCC continue to support the infrastructure of an early childhood education quality improvement framework, including QRIS.
Additionally, with respect to Head Start, there are 50,000 Head Start and Early Head Start classrooms across the country in diverse settings ranging from New York City to the bottom of the Grand Canyon. Changing teacher behavior and practices at the ground level to improve the quality of the classroom is a formidable challenge, particularly in highly rural areas, American Indian and Alaska Native programs, and Migrant and Seasonal Head Start programs where finding qualified staff can be difficult due to more limited access to higher education. OHS is using multiple approaches to address this challenge, including policy levers, training and technical assistance, and professional development efforts.
Agency Priority Goal:
Improve health care through meaningful use of health information technology.
Statement:
By the end of FY2015, increase the number of eligible providers who receive incentive payments from the CMS Medicare and Medicaid EHR Incentive Programs for the successful adoption or demonstration of meaningful use of certified EHR technology to 450,000.
Description:
At the heart of HHS’s strategy to strengthen and modernize healthcare is the use of data to improve healthcare quality, reduce unnecessary healthcare costs, decrease paperwork, expand access to affordable care, improve population health, and support reformed payment structures. The nation’s health information technology infrastructure enables the flow of information to power these critical efforts— that can help facilitate the types of fundamental changes in access and healthcare delivery proposed in the Affordable Care Act. HHS is taking a leading role in realizing health information technology’s potential benefits. The Recovery Act provided an unprecedented investment in health information technology to propel a range of initiatives, including regulations on the meaningful use of health information technology and standards as well as the funding of Health IT Regional Extension Centers, State Health Information Exchanges, and other programs.
This Priority Goal is to increase the number of eligible providers in these important programs who adopt/meaningfully use electronic health records (EHRs), since it is believed that the increased use of EHRs will improve coordination across providers and settings, improve health care delivery, improve quality of care and reduce medical errors. The Office of the National Coordinator for Health IT within the Office of the Secretary of Health and Human Services is the designated lead for this priority goal in close partnership with the Centers for Medicare & Medicaid Services (CMS). A key step in this strategy is to provide incentive payments to eligible providers serving Medicare and Medicaid beneficiaries who adopt and meaningfully use certified EHR technology.
Detailed reports showing the provider types and EHR Incentive Programs breakouts are available on the CMS website at http://www.cms.gov/EHRIncentivePrograms/56_DataAndReports.asp
