A Review of the HHS Family Planning Program Mission, Management, and Measurement of Results (2009) / Chapter Skim
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5 Collection of Data to Measure Program Outcomes
5 Collection of Data to Measure Program Outcomes
Pages 145-170
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From page 145... ...
This is followed by an assessment of the data collection infrastructure for the Title X program. The chapter ends with conclusions and recommendations for improving the Title X evaluation system as a whole, drawing on recommendations from earlier groups as well as this committee.
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From page 146... ...
increasing the number of unintended pregnancies averted by providing Title X family planning services, with priority for services to low-income individuals; (2) reducing infertility among women attending family planning clinics by identifying chlamydia infection through screening of females aged 15–24; and (3)
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From page 147... ...
. The use of this framework offers an opportunity to place the discussion of quality of care within the broader context of national and various state health policies and Title X financing as enabling factors for the Title X program, patient care, and education and outreach.
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. Second, OPA uses FPAR data to comply with accountability and federal performance requirements for recipients of Title X family planning funds as required by the 1993 Government Performance and Results Act (GPRA)
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. Each year, FPAR data are analyzed to produce the Family Planning Annual Report National Summary.
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Data on the Title X program that may be useful for evaluation purposes are also available from several other sources. These include, for example, contracts that are funded by HHS 1 percent evaluation funds, the Service Delivery Improvement grant program, family planning research cooperative agreements, and demonstration projects aimed at addressing key program initiatives (see Appendix I)
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From page 151... ...
Recommendations for filling the identified gaps are presented at the end of the chapter. Adequacy of the Data Collection Infrastructure Client Need Consistent with column 1 of the committee's evaluation framework, a key goal of the Title X program is to provide services to low-income, uninsured individuals; ethnically/racially and linguistically diverse women and men; and adolescents.
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Report that planning services to 2. Decreased Measure to b.
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Clear information is as HPV protocols offered (bilingual immunization and 5. Training and counseling offered Pap tests, to be technical for those with defined by an expert assistance limited English committee)
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From page 154... ...
It would be useful if the FPAR could collect more group-specific data in order to detect the effect of small changes in the performance indicators based on race and ethnicity, age and gender, level of income, and level of education. For example, this type of data could include unduplicated number of family planning users by age and gender; ethnicity and race; income level; limited English proficiency; primary contraceptive method; and number of gonorrhea, syphilis, HIV, and chlamydia tests.
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From page 155... ...
To date, OFP has relied primarily on the NSFG to gather population-level data, and it might be possible for the NSFG to collect these types of data. Other data currently collected under cooperative agreements with OPA specifically examine the population in need of publicly funded family planning and how much of that need is met by family planning clinics, whether funded through Title X or not, at the state and county levels.
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From page 156... ...
Gaps While both the FPAR and CPR collect substantial information on structural factors in clinic settings, it is not clear how the two sources are used to inform each other. For example, although the FPAR collects some information on the number of family planning users who have limited English proficiency, more specific information is needed about the availability or quality of interpreters or the bilingual nature of staff to determine whether the needs of these clients at any given clinic are being met.
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From page 157... ...
The PRT also notes whether clinic protocols are in place, such as those for follow-up for women and their partners when a chlamydia test is positive. The FPAR collects data on the number of Pap tests performed that had an atypical squamous cells or high-grade squamous intraepithelial lesion or higher result, as well as the number of family planning users who obtained a clinical breast exam and were referred for further evaluation.
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From page 158... ...
Although the FPAR captures client service data, it collects no specific quality measures for those services. The FPAR does not appear to collect data on many aspects of the process of care, such as the length of wait time to schedule a visit for different types of care (emergency contraception, initial family planning, pregnancy testing, fertility counseling, HIV testing)
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. As noted above, different methods could be used to collect data directly from clients, including telephone interviews, surveys, exit interviews, and community focus groups, depending on the specific evaluation question and the sampling plan for clinics selected to capture different types of clients and visits.
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increasing family planning services to low-income clients to decrease the number of unintended pregnancies, (2) increasing screening of females aged 15–24 for chlamydia infection to reduce infertility, and (3)
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Family planning agencies could consider linking through information technology to local and state health departments for this information. As part of this process, expert consultation will be needed to determine whether the performance measures themselves should be modified.
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For this assessment, the committee placed the greatest emphasis on the goal of increasing family planning services to low-income clients to decrease the number of unintended pregnancies since this is the predominant reason for visiting a family planning clinic. As discussed above, the committee suggests that OFP revisit the outcomes selected for evaluating the program's impact on population health.
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From page 163... ...
Research on contraceptive use in the absence he Frost et al. paper actually models the impact of publicly funding family planning T clinic services, not Title X clinics specifically.
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In a recent review, Kirby (2008) found that there is a significant lack of research and evaluation on interventions to promote the use of family planning methods, a lack that severely limits the nation's ability to help couples both plan for pregnancy and prevent unintended pregnancy.
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From page 165... ...
Given that long-acting methods such as the IUD or the implant are more effective and cost-effective, it would be useful to track not only the availability of these methods at each family planning clinic visit, but also their prescription rate at the visit. Lastly, the 2006 FPAR reports that 15 percent of women using Title X services were not using birth control, were pregnant, or wanted to be.
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The following recommendations are intended to help OFP strengthen its ability to meet its goals through improved data collection. These recommendations are based on recent literature reviews and reports on quality in the provision of family planning services (Sonenstein, 2006; Becker et al., 2007)
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Recommendation 5-2: Examine the data elements of the Family Planning Annual Report (FPAR)
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explore how the Title X program can reduce unintended pregnancies more effectively; (2) be linked directly to improving the nation's family
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From page 169... ...
If the data collection system is not incorporating new program priorities, the efforts of grantees to respond to those priorities may not be fully captured. The FPAR was last modified in 2005 (to include new data elements, such as user health insurance coverage, English proficiency, contraceptive use by males, summary Pap [abnormal]
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From page 170... ...
Equally important, it could help clinic staff understand the significance of their work on collecting FPAR data. CONCLUDING THOUGHTS The committee has identified a variety of ways in which the Title X program could be improved.
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