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, MD, MPH NCHS Data Users Conference July 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 Statistics Centers for Disease Control and Prevention Washington D.C. July 12, 2006 Healthy People 2010 Midcourse 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 Formerly Developmental 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 DateActivity Milestone June - December 2004Propose changes to objectives (modifications, additions, deletions) December 2004Data cutoff August - Sept day public comment period January – Dec 2005Produce draft MCR document Fall 2006Release/publish MCR

Healthy People 2010: Measuring Progress Toward Objective Targets Jeff N. Pearcy, MS Zakia C. Nelson, MPH Richard J. Klein, MPH National Center for Health Statistics Centers 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

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 100 Most 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

Progress Quotient (cont.) Special circumstances More than 100% positive or negative

Progress Quotient (cont.) Special circumstances More than 100% positive or negative Unable to compute PQ No follow up data

5% in school: grades 9-12 (1999, 2003) Physical activity in physical8% education class: grades 9-12 (1999, 2003) Television viewing: grades % (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 data year used to compute the percent of the HealthyPeople 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

3 Objective 10-3c Baseline: 3% Most recent: 1% Target: 3% PQ = -2 / 0 4 Objective 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

1 Objective 10-3a Baseline: 0.0% Most recent: 0.1% Target: 0.0% PQ = 0.1 / 0 2 Objective 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% Baseline Black or African-American only 2010 Target = 56% Target met 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 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 cent API

Median Annualized Percent Improvement Population based data with baseline and follow-up data Total Population Race 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 white Gender Female Male Education level Less than 12 years 12 years 13 years or more Income level Poor or equivalent Near poor or equivalent Middle/High or equivalent Geographic location Urban/metropolitan Rural/nonmetropolitan Disability 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 100 Projected (2008) value – baseline value Year 2010 target – baseline value                       baseline year API value 2008 ^ 100 1* 2008

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 midcourse Cannot assess Tracking data available N=467 Total objectives in HP2010 N=281 objectives with tracking data Met or exceeded the target Moved towards the target Did not change Mixed (towards and away) Moved away from the target 49% N=137 15% N=41 6% N=17 20% N=57 10% N=29 }

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 %42.1 %-28.0 % 1.4 %3.1 %-2.2 % Overall AwayTowards

Summary of Progress Measures Median PQ Median API %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