DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Health
Resources and Services Administration
HEALTH
CARE PLAN
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FOR HRSA USE ONLY
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Grantee Name
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Application Tracking Number
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Budget Period Date
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Focus Area: Diabetes
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Performance Measure:
Percentage
of diabetic patients whose HbA1c levels are less than or
equal to 9 percent
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Is this Performance Measure
Applicable to your Organization?
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[_] Yes [_] No
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Target Goal Description
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Numerator Description
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Number of adult patients age
18 to 75 years with a diagnosis of Type 1 or Type 2 diabetes
whose most recent hemoglobin A1c level during the measurement
year is ≤ 9%, among those patients included in the
denominator.
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Denominator Description
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Number of adult patients age
18 to 75 years as of December 31 of the measurement year with
a diagnosis of Type 1 or Type 2 diabetes, who have been seen
in the clinic at least twice during the reporting year and do
not meet any of the exclusion criteria
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Baseline Data
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Baseline Year:
Measure
Type:
Numerator:
Denominator:
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Projected Data (by End of
Project Period)
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Data Source & Methodology
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Progress Toward Goal
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Quantitative:
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Qualitative:
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Comments
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Focus Area: Cardiovascular
Disease
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Performance Measure:
Percentage
of adult patients with diagnosed hypertension whose most
recent blood pressure was less than 140/90
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Is this Performance Measure
Applicable to your Organization?
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[_] Yes [_] No
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Target Goal Description
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Numerator Description
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Patients 18 to 85 years with a
diagnosis of hypertension with most recent systolic blood
pressure measurement < 140 mm Hg and diastolic blood
pressure < 90 mm Hg.
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Denominator Description
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All patients 18 to 85 years of
age as of December 31 of the measurement year with diagnosis
of hypertension and have been seen at least twice during the
reporting year, and have a diagnosis of hypertension.
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Baseline Data
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Baseline Year:
Measure
Type:
Numerator:
Denominator:
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Projected Data (by End of
Project Period)
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Data Source & Methodology
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Progress Toward Goal
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Quantitative:
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Qualitative:
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Comments
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Focus Area: Cancer
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Performance Measure:
Percentage of women age 21-64 who received one or more Pap
tests during the measurement year or during the two years
prior to the measurement year.
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Is this Performance Measure
Applicable to your Organization?
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[_] Yes [_] No
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Target Goal Description
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Numerator Description
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Number of female patients 24 –
64 years of age receiving one or more Pap tests during the
measurement year or during the two years prior to the
measurement year, among those women included in the
denominator.
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Denominator Description
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Number of female patients age
24-64 years of age during the measurement year who were seen
for a medical encounter at least once during 2009 and were
first seen by the grantee before their 65th
birthday.
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Baseline Data
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Baseline Year:
Measure
Type:
Numerator:
Denominator:
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Projected Data (by End of
Project Period)
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Data Source & Methodology
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Progress Toward Goal
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Quantitative:
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Qualitative:
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Comments
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Focus Area: Prenatal and
Perinatal Health
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Performance Measure:
Percentage
of pregnant women beginning prenatal care in first trimester
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Is this Performance Measure
Applicable to your Organization?
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[_] Yes [_] No
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Target Goal Description
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Numerator Description
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All female patients who
received perinatal care during the measurement year
(regardless of when they began care) who initiated care in
the first trimester either at the grantee’s service
delivery location or with another provider.
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Denominator Description
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Number of female patients who
received prenatal care during the measurement year
(regardless of when they began care), either at the grantee’s
service delivery location or with another provider.
Initiation of care means the first visit with a clinical
provider (MD, NP, CNM) where the initial physical exam was
done and does not include a visit at which pregnancy was
diagnosed or one where initial tests were done or vitamins
were prescribed.
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Baseline Data
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Baseline Year:
Measure
Type:
Numerator:
Denominator:
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Projected Data (by End of
Project Period)
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Data Source & Methodology
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Progress Toward Goal
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Quantitative:
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Qualitative:
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Comments
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Focus Area: Prenatal and
Perinatal Health
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Performance Measure:
Percentage
of births less than 2,500 grams to health center patients.
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Is this Performance Measure
Applicable to your Organization?
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[_] Yes [_] No
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Target Goal Description
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Numerator Description
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Women in the “Universe”
whose child weighed less than 2,500 grams during the
measurement year, regardless of who did the delivery.
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Denominator Description
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Total births for all women who
were seen for prenatal care during the measurement year
regardless of who did the delivery.
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Baseline Data
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Baseline Year:
Measure
Type:
Numerator:
Denominator:
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Projected Data (by End of
Project Period)
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Data Source & Methodology
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Progress Toward Goal
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Quantitative:
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Qualitative:
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Comments
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Focus Area: Child Health
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Performance Measure:
Percentage
of children with 2nd birthday during the measurement year
with appropriate immunizations.
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Is this Performance Measure
Applicable to your Organization?
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[_] Yes [_] No
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Target Goal Description
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Numerator Description
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Number of children in the
“universe” who received all of the following: 4
DTP/DTaP, 3 IPV, 1 MMR, 3 Hib, 3 HepB, 1VZV (Varicella) and 4
Pneumoccocal conjugate, prior to or on their 2nd
birthday whose second birthday occurred during the
measurement year (prior to 31 December), among those children
included in the denominator.
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Denominator Description
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Number of children with at
least one medical encounter during the reporting period, who
had their second birthday during the reporting period, who
did not have a contraindication for a specific vaccine, who
were seen for the first time in the clinic prior to their
second birthday, regardless of whether or not they came to
the clinic for vaccinations or well child care.
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Baseline Data
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Baseline Year:
Measure
Type:
Numerator:
Denominator:
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Projected Data (by End of
Project Period)
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Data Source & Methodology
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Progress Toward Goal
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Quantitative:
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Qualitative:
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Comments
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Focus Area: Behavioral Health
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Performance Measure:
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Is this Performance Measure
Applicable to your Organization?
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[_] Yes [_] No
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Target Goal Description
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Numerator Description
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Denominator Description
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Baseline Data
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Baseline Year:
Measure
Type:
Numerator:
Denominator:
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Projected Data (by End of
Project Period)
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Data Source & Methodology
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Progress Toward Goal
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Quantitative:
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Qualitative:
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Comments
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Focus Area: Oral Health
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Performance Measure:
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Is this Performance Measure
Applicable to your Organization?
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[_] Yes [_] No
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Target Goal Description
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Numerator Description
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Denominator Description
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Baseline Data
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Baseline Year:
Measure
Type:
Numerator:
Denominator:
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Projected Data (by End of
Project Period)
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Data Source & Methodology
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Progress Toward Goal
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Quantitative:
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Qualitative:
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Comments
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Focus Area: Other
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Performance Measure:
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Is this Performance Measure
Applicable to your Organization?
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[_] Yes [_] No
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Target Goal Description
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Numerator Description
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Denominator Description
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Baseline Data
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Baseline Year:
Measure
Type:
Numerator:
Denominator:
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Projected Data (by End of
Project Period)
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Data Source & Methodology
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Progress Toward Goal
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Quantitative:
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Qualitative:
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Comments
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