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,

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)


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











19

-100 -75 -50 -25 0 25 50 75 100











19

-100 -75 -50 -25 0 25 50 75 100











19

-100 -75 -50 -25 0 25 50 75 100


Special circumstances

More than 100% positive or negative


Focus Area 9: Midcourse Status Family Planning

-100 -75 -50 -25 0 25 50 75 100


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%


Focus Area 9. Midcourse StatusFamily Planning (continued)

-100 -75 -50 -25 0 25 50 75 100


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( )




Unable to compute PQ

No follow up data


Focus Area 22: Midcourse StatusPhysical Activity and Fitness

-100 -75 -50 -25 0 25 50 75 100


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.





No follow up data

Target met at baseline

Progress in desired direction


Focus Area 10: Midcourse StatusFood Safety

-100 -75 -50 -25 0 25 50 75 100


*, 1

*, 2


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





No follow up data

Target met at baseline

Progress in desired direction

Progress in undesired direction


Focus Area 10: Midcourse StatusFood Safety

-100 -75 -50 -25 0 25 50 75 100


*, 1

*, 2


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

[email protected]; [email protected] ;[email protected]

Documents

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,