Healthy People 2010 Mid-Decade Assessment of Progress: Methods and Results Richard J. Klein, MPH Erin B. Reidy, MA Suzanne P. Hallquist, MSPH Asel Ryskulova,
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Healthy People 2010 Mid-Decade Assessment of
Progress: Methods and Results
Richard J. Klein, MPHErin B. Reidy, MA
Suzanne P. Hallquist, MSPHAsel Ryskulova, MD, MPH
NCHS Data Users ConferenceJuly 12, 2006
Session Agenda
• Healthy People 2010 Midcourse Review Overview (Richard)
• Measuring Progress Toward Objective Targets (Richard)
• Measuring Progress Toward Goal 1: Increase the Quality and Years of Healthy Life (Erin)
• Measuring Progress Toward Goal 2: Eliminate Health Disparities (Suzanne)
• DATA2010 Demonstration (Asel)
• Question and Answer Session
Richard J Klein, MPH
National Center for Health StatisticsCenters for Disease Control and Prevention
Washington D.C.July 12, 2006
Healthy People 2010Midcourse Review
Overview
Midcourse Review (MCR) Purpose
• Assess progress towards goals and objectives as of January 2005
• Identify areas that are successful or facing challenges
• Determine objectives to be modified or eliminated
Developmental Objectives
• No baseline data at November 2000 publication of HP2010
• “Developmental objectives with no data by midcourse will be dropped.”
• Retained at midcourse only if Baseline data obtained; or Data source identified and funding commitment made
by 12/31/2004
Developmental Objectives
Of the 140 originally developmental objectives:
• 84 objectives moved from developmental to measurable status
• 29 retained as developmental
• 27 proposed for deletion
Target Setting for FormerlyDevelopmental Objectives
• Population-based: One unit better than the best (BTTB) race/ethnic (R/E) group
• Not population-based: Consistent with similar objectives in focus area
Proportional Target Adjustments
• Were made to measures with baseline changes to total population
• Targets adjusted proportionally using original target-setting method
• 145 measures had target adjustments
Public Comment Period
• Opportunity for public to comment on MCR modifications
• Several changes have been proposed as a result of public comment
Midcourse Review Timeline
Date Activity Milestone
June - December 2004 Propose changes to objectives (modifications, additions, deletions)
December 2004 Data cutoff
August - Sept 2005 30-day public comment period
January – Dec 2005 Produce draft MCR document
Fall 2006 Release/publish MCR
Healthy People 2010: Measuring Progress
Toward Objective Targets
Jeff N. Pearcy, MSZakia C. Nelson, MPHRichard J. Klein, MPH
National Center for Health StatisticsCenters for Disease Control and Prevention
Washington, D.C.July 12, 2006
Assessing Progress – Midcourse Review
1. Assess HP 2010 goals
Increase quality and years of healthy life
Eliminate health disparities
2. Assess progress toward HP2010 targets
Progress towards targets is one way to measure Goal 1 success
• 467 objectives (+ subobjectives)
955 measures overall (888 retained after MCR)
• 498 retained measures with tracking data
375 population-based measures
132 non-population based measures
• Evaluate progress for each measure using several metrics
Assessing progress toward HP2010 targets
Metrics for measuring progress
• Progress Quotient
Measures progress to date
Percent of targeted change achieved
• Annualized Percent Improvement
Adjusts rates of progress for different tracking periods
• Projected Progress Quotient
Expectation for attaining target
• Summary Measures of Health
Combine mortality and morbidity into a single measure
Progress Quotient
Progress Quotient
• Percent of targeted change achieved between baseline data year and most recent data point
• PQ =
• Positive when moving towards target, and negative when moving away from target
x 100Most recent value – baseline value
Year 2010 target – baseline value
Progress Quotient (cont.)
Characteristics
Used since 1995 Midcourse Review
Relative measure
Adverse or positive outcome doesn’t affect calculation
Indicates progress made so far
Moved away from target Moved toward target Met target
Focus Area 1: Midcourse StatusAccess to Quality Health Services (continued)
Percent of targeted change achieved
1-9. Hospitalization (1996, 2001)a. Pediatric asthma: < 18 years 28%
b. Uncontrolled diabetes: -28%18-64 years
c. Immunization-preventable -23%pneumonia or influenza: 65+ years
1-12. Single toll-free number for poison 100%control centers (1999, 2001)
1-14a. Pediatric protocols for online 79%medical direction (1997, 2000)
1-14b. Pediatric guidelines for emergency 73%and critical care (1997, 2000)
1-16. Pressure ulcers: nursing home -13%residents (1997, 1999)
19
-100 -75 -50 -25 0 25 50 75 100
Moved away from target Moved toward target Met target
Focus Area 1: Midcourse StatusAccess to Quality Health Services (continued)
Percent of targeted change achieved
1-9. Hospitalization (1996, 2001)a. Pediatric asthma: < 18 years 28%
b. Uncontrolled diabetes: -28%18-64 years
c. Immunization-preventable -23%pneumonia or influenza: 65+ years
1-12. Single toll-free number for poison 100%control centers (1999, 2001)
1-14a. Pediatric protocols for online 79%medical direction (1997, 2000)
1-14b. Pediatric guidelines for emergency 73%and critical care (1997, 2000)
1-16. Pressure ulcers: nursing home -13%residents (1997, 1999)
19
-100 -75 -50 -25 0 25 50 75 100
Moved away from target Moved toward target Met target
Focus Area 1: Midcourse StatusAccess to Quality Health Services (continued)
Percent of targeted change achieved
1-9. Hospitalization (1996, 2001)a. Pediatric asthma: < 18 years 28%
b. Uncontrolled diabetes: -28%18-64 years
c. Immunization-preventable -23%pneumonia or influenza: 65+ years
1-12. Single toll-free number for poison 100%control centers (1999, 2001)
1-14a. Pediatric protocols for online 79%medical direction (1997, 2000)
1-14b. Pediatric guidelines for emergency 73%and critical care (1997, 2000)
1-16. Pressure ulcers: nursing home -13%residents (1997, 1999)
19
-100 -75 -50 -25 0 25 50 75 100
Moved away from target Moved toward target Met target
Focus Area 1: Midcourse StatusAccess to Quality Health Services (continued)
Percent of targeted change achieved
1-9. Hospitalization (1996, 2001)a. Pediatric asthma: < 18 years 28%
b. Uncontrolled diabetes: -28%18-64 years
c. Immunization-preventable -23%pneumonia or influenza: 65+ years
1-12. Single toll-free number for poison 100%control centers (1999, 2001)
1-14a. Pediatric protocols for online 79%medical direction (1997, 2000)
1-14b. Pediatric guidelines for emergency 73%and critical care (1997, 2000)
1-16. Pressure ulcers: nursing home -13%residents (1997, 1999)
19
-100 -75 -50 -25 0 25 50 75 100
Progress Quotient (cont.)
Special circumstances
More than 100% positive or negative
Moved away from target Moved toward target Met target
Focus Area 9: Midcourse Status Family Planning
-100 -75 -50 -25 0 25 50 75 100
Percent of targeted change achieved
Page 1 of 2 See notes at end of chart.
9-2. Births within 24 months of a -140%previous birth: females 15-44 years (1995, 2002)
9-3. Contraceptive use: females -57%15-44 years at risk of unintended pregnancy (1995, 2002)
9-5. Emergency contraception provided -10%by family planning agencies
(1999, 2003)
9-7. Pregnancy: females 15-17 years 54%(1996, 2000)
9-8. Abstinence before age 15 years(1995, 2002)
a. Females 15-19 years 86%
b. Males 15-19 years 67%
9-9. Abstinence: ages 15-17 years(1995, 2002)
a. Females 62%
b. Males 61%9-10. Condom use at first intercourse
(1995, 2002)a. Unmarried females 15-17 33%
years
b. Unmarried males 15-17 years 46%
Moved away from target Moved toward target Met target
Focus Area 9. Midcourse StatusFamily Planning (continued)
-100 -75 -50 -25 0 25 50 75 100
Percent of targeted change achieved
NOTES: Tracking data for Objectives 9-1, 9-4, 9-6, 9-11a through 9-11p, and 9-13 areunavailable.
Years in parentheses represent the baseline data year and the most recent datayear used to compute the percent of the Healthy People 2010 target achieved.
Page 2 of 2
9-10. Condom plus hormonal methodat first intercourse
c. Unmarried females 15-17 450%years
d. Unmarried males 15-17 years 133%
Condom use at last intercoursee. Unmarried females 15-17 170%
years
f. Unmarried males 15-17 years 156%
Condom plus hormonal methodat last intercourse
g. Unmarried females 15-17 425%years
h. Unmarried males 15-17 years 200%
9-12. Problems initiating or maintaining -67% a pregnancy: wives 15-44 years(1995, 2002)
Most recent value – baseline value——————————————Year 2010 target – baseline value
Percent of targeted change achieved = X 100( )
Progress Quotient (cont.)
Special circumstances
More than 100% positive or negative
Unable to compute PQ
No follow up data
Moved away from target Moved toward target Met target
Focus Area 22: Midcourse StatusPhysical Activity and Fitness
-100 -75 -50 -25 0 25 50 75 100
Percent of targeted change achieved
22-1. No leisure-time physical activity: 15%18+ years (1997, 2003)
22-2. Regular physical activity: moderate 6%or vigorous, 18+ years (1997, 2003)
22-3. Regular physical activity: 14%vigorous, 18+ years (1997, 2003)
22-4. Muscular strength and endurance: 17%18+ years (1998, 2003)
22-5. Flexibility: 18+ years (1998, 2001) 8%
22-6. Moderate physical activity: -25%grades 9-12 (1999, 2003)
22-7. Vigorous physical activity: -10%grades 9-12 (1999, 2003)
22-9. Participation in daily physical activity -5%in school: grades 9-12 (1999, 2003)
22-10. Physical activity in physical 8%education class: grades 9-12(1999, 2003)
22-11. Television viewing: grades 9- 12 28%(1999, 2003)
NOTES: Tracking data for Objectives 22-8a, 22-8b, 22-12, 22-13, 22-14a, 22-14b, 22-15a,and 22-15b are unavailable.
Years in parentheses represent the baseline data year and the most recent datayear used to compute the percent of the Healthy People 2010 target achieved.
Progress Quotient (cont.)
Special circumstances
More than 100% positive or negative
Unable to compute PQ
No follow up data
Target met at baseline
Progress in desired direction
Moved away from target Moved toward target Met target
Focus Area 10: Midcourse StatusFood Safety
-100 -75 -50 -25 0 25 50 75 100
Page 1 of 2 See notes at end of chart.
*, 1
*, 2
Percent of targeted change achieved
10-1. Foodborne infections (1997, 2002)a. Campylobacter species 92%
b. Escherichia coli O157:H7 36%
c. Listeria monocytogenes 91%
d. Salmonella species -38%
f. Postdiarrheal hemolytic uremic -12%syndrome: < 5 years (2000, 2002)
10-2. Outbreaks of foodborne infection(1997, 2002)
a. Escherichia coli 0157:H7 -145%
b. Salmonella serotype Enteritidis 68%10-3. Non-Typhi Salmonella species from
humans resistant to a. Fluoroquinolones (1997, 2002)
b. Third-generation cephalosporins(1997, 2002)
c. Gentamicin (1997, 2002) 100%*, 3
d. Ampicillin (1997, 2002) 100%*, 4
3Objective 10-3c
Baseline: 3%Most recent: 1%
Target: 3%
PQ = -2 / 0
4Objective 10-3d
Baseline: 18%Most recent: 13%
Target: 18%
PQ = -5 / 0
Progress Quotient (cont.)
Special circumstances
More than 100% positive or negative
Unable to compute PQ
No follow up data
Target met at baseline
Progress in desired direction
Progress in undesired direction
Moved away from target Moved toward target Met target
Focus Area 10: Midcourse StatusFood Safety
-100 -75 -50 -25 0 25 50 75 100
Page 1 of 2 See notes at end of chart.
*, 1
*, 2
Percent of targeted change achieved
10-1. Foodborne infections (1997, 2002)a. Campylobacter species 92%
b. Escherichia coli O157:H7 36%
c. Listeria monocytogenes 91%
d. Salmonella species -38%
f. Postdiarrheal hemolytic uremic -12%syndrome: < 5 years (2000, 2002)
10-2. Outbreaks of foodborne infection(1997, 2002)
a. Escherichia coli 0157:H7 -145%
b. Salmonella serotype Enteritidis 68%10-3. Non-Typhi Salmonella species from
humans resistant to a. Fluoroquinolones (1997, 2002)
b. Third-generation cephalosporins(1997, 2002)
c. Gentamicin (1997, 2002) 100%*, 3
d. Ampicillin (1997, 2002) 100%*, 4
1Objective 10-3a
Baseline: 0.0%Most recent: 0.1%
Target: 0.0%
PQ = 0.1 / 0
2Objective 10-3b
Baseline: 0.0%Most recent: 0.2%
Target: 0.0%
PQ = 0.2 / 0
Progress Quotient - limitations
• Lack of standard method for evaluating statistical significance
Can use permutation procedure to estimate variance and confidence interval of PQ
Procedure requires standard errors for rates used to calculate PQ (not available for all objectives)
• Does not account for # of years in tracking period
• Does not account for trend
Attain then miss Target
0%
20%
40%
60%
80%
100%
120%
140%
Basel
ine
1998 1999 2000 2001 2002 2003
Black or African-American only
2010Target = 56%
Target met
14-18 Decrease use (%)Antibiotics prescribed for ear infections - children
Progress Quotient - limitations
• For some measures, test for trend would provide more insight into progress
Theil test to evaluate significance of trend
Requires 5+ data points
• Confidence intervals and Theil test not used for MCR, but planned for Final Review
Annualized Percent Improvement
Annualized Percent Improvement
• Annualized improvement assumes a constant rate of change
• Allows comparisons of rate of progress between objectives or population groups with tracking periods of different length
100*1^Re
*1 #1
years
Baseline
centAPI
-2.4-2.3
-7.7-2.6
-2.3-2.0
-2.3
-2.5-2.5
-1.0
-2.3-2.6
-2.7-2.1
-2.4-5.1-4.8-5.0
-3.3-1.8
-2.2
1.52.9
2.42.0
2.9
3.1
2.21.81.8
3.02.8
3.52.73.0
5.06.6
4.73.53.9
3.1
3.3
-10 -8 -6 -4 -2 0 2 4 6 8 10
Median Annualized Percent ImprovementPopulation based data with baseline and follow-up data
Total PopulationRace and ethnicity American Indian / Alaska Native Asian or Pacific Islander Asian Only Hawaiian other Pacific Islander 2 or more races Hispanic Not Hispanic black Not Hispanic whiteGender Female MaleEducation level Less than 12 years 12 years 13 years or moreIncome level Poor or equivalent Near poor or equivalent Middle/High or equivalentGeographic location Urban/metropolitan Rural/nonmetropolitanDisability status Persons with disabilities Persons without disabilities
Percent
Projected Progress Quotient
• Percent of targeted change expected to be achieved by end of tracking period (2008) given same rate of change as in first half of decade
PPQ =
• A way to estimate what proportion of objectives and sub-objectives will meet their targets
Projected Progress Quotient
x 100Projected (2008) value – baseline value
Year 2010 target – baseline value
baseline yearAPI
value2008
^100
1*1002008
Summary of Progress
Figure 1. Healthy People 2010 objectives: Status at the midcourse and summary of progress toward target attainment
60%N=281
34%N=158
6%N=28
Dropped at midcourseCannot assessTracking data available
N=467 Total objectives in HP2010
N=281 objectives with tracking data
Met or exceeded the targetMoved towards the targetDid not changeMixed (towards and away)Moved away from the target
49%N=137
15%N=41
6%N=17
20%N=57
10%N=29
}
0
5
10
15
20
25
30
35
40
45
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
Healthy People 2010 Focus Areas
Number of objectives (N = 467)
Figure 2. Healthy People 2010 objectives: Status at the midcourse by focus area
Dropped at midcourse
Cannot assess
Moved away from the target
Mixed (towards and away)
Did not change
Moved towards the target
Met or exceeded the target
Summary of Progress
Measures
Median PQ
Median API
506 355 112
19.0 % 42.1 % -28.0 %
1.4 % 3.1 % -2.2 %
Overall AwayTowards
Summary of Progress
Measures
Median PQ
Median API
506 355 112
19.0 % 42.1 % -28.0 %
1.4 % 3.1 % -2.2 %
Overall AwayTowards
Conclusions
• MCR is a comprehensive assessment of the objectives and progress
• Progress can be assessed using several metrics
• Most objectives are moving towards the targets (although only 10% have met)
Contact Information
Jeff Pearcy; Zakia Coriaty Nelson; Richard Klein
Centers for Disease Control and Prevention
National Center for Health Statistics
3311 Toledo Road,
Hyattsville, MD 20782
jpearcy@cdc.gov; znelson@cdc.gov ;rklein@cdc.gov
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