Justification for Non substantive change

Health Resources and Services Administration

Uniform Data System

Subject: Request for non-substantive change to an existing agency data collection activity approved by OMB under #0915-0193

This is a request for a non-material or non-substantive change to a currently approved OMB approval for the Health Resources and Services Administration’s Uniform Data System Information Collection. The current OMB approval is under #0915-0193, which expires 02/28/2015.

PROPOSED UNIFORM DATA SYSTEM CHANGES FOR 2013

1. Clinical Performance Measures

1. Childhood immunization

1. Remove Hepatitis A, Rotavirus, and Influenza immunizations from the immunization test battery.

2. Revise the time frame for shot completion from by age 2 to by 35 months.

Reason for proposed change: The addition of these 3 shots decreased grantee compliance from 73% in 2010 to 44% in 2011. A major reason for the decrease cited by grantees and clinical advisors was narrow timing windows for shot administration. Removal of the 3 shots reverts the battery of shots to those reported in 2008 to 2010, and will facilitate grantee quality improvement.

2. Cervical cancer screening

Count as compliant women age 24 to 64 years with a Pap test every 3 years and count as compliant women age 30 to 64 years who choose a 5 year interval for Pap tests when accompanied by an HPV test.

Reason for proposed change: Whereas the current measure counts as compliant women age 24 to 64 years with 3 year intervals between screenings, the revision allows 5 year intervals for women age 30 to 64 years with a Pap test accompanied by an HPV test. This change aligns with the 2012 recommendation of the Preventive Services Task Force.

2. Insurance Source by Zip Codes and Age

1. Grantees will report patient data by zip codes and insurance category (none/uninsured, Medicaid/CHIP/Other Public, Medicare and Private Insurance).

Reason for proposed change: While zip code and insurance data already are collected in the UDS, reporting in this format would permit analysis of service area data and insurance categories in the US Census/American Community Survey. These data would enable comparison of changes in health center patient origin by changes in community level insurance as the Affordable Care Act is implemented.

2. The age break for summarizing insurance source data is changed from 19 years to 17 years.

Reason for Proposed Change: While detailed data by age already are collected in the UDS, reporting insurance source data using this age break will enable comparison with national US Census/American Community Survey data.

Questions and Answers for Table 6b

1. Are there any changes to the table this year?

Yes, two changes have been made to existing measures. First, the childhood immunization measure now reflects the CDC “catch-up” immunization standards. These standards look at children prior to their third birthday (rather than on their second birthday) and do not include the Rotavirus, Hep-A, or Flu vaccines previously tested for. Second, the Pap test measure reflects changes that have been recommended by the U.S. Preventive Services Task Force. These changes permit a woman over the age of 30 who receives a Pap test and a test for HPV at the same time to be considered to be in compliance for a period of five years rather than three. These women will be counted as compliant in the number of patients tested (line 11c).

2. For women who are seen after they are over the age of 30, can we use either of the test protocols?
   Yes. For these women, compliance can be documented either by showing that they had a Pap test during the measurement year or the prior two years or that they had a Pap test and a HPV test at the same time during the measurement year or the prior four years.

Reporting Period: January 1, 20123 through December 31, 20123

TABLE 6B – QUALITY OF CARE INDICATORS

(No prenatal care provided? Check here: )

Section A: Age Categories for Prenatal Patients (GRANTEES WHO PROVIDE PRENATAL CARE ONLY)
DEMOGRAPHIC CHARACTERISTICS OF PRENATAL CARE PATIENTS
AGE			NUMBER OF PATIENTS ( a )
1	Less than 15 years
2	Ages 15-19
3	Ages 20-24
4	Ages 25-44
5	Ages 45 and Over
6	Total Patients (Sum lines 1 – 5)
Section B – Trimester of Entry Into Prenatal Care
Trimester of First Known Visit for Women Receiving Prenatal Care During Reporting Year		Women Having First Visit with Grantee ( a )			Women Having First Visit with Another Provider ( b )
7	First Trimester
8	Second Trimester
9	Third Trimester
Section C – Childhood Immunization
Childhood Immunization		Total Number of patients with 2nd 3rd birthday during measurement year ( a )		Number Charts Sampled or EHR total ( b )		Number of Patients Immunized ( c )
10	MEASURE: Children who have received age appropriate vaccines who had their 2nd prior to reaching their 3rd birthday during measurement year (on or prior to 31 December)
Section D – Cervical Cancer Screening
Pap Tests1		Total number of Female Patients 24-64 years of Age ( a )		Number Charts Sampled or EHR total ( b )		Number of Patients Tested ( c )
11	MEASURE: Female patients aged 24-64 who received one or more Pap tests to screen for cervical cancer
Section E – Weight Assessment and Counseling for Children and Adolescents
Child and Adolescent Weight Assessment and Counseling		Total patients aged 3 – 17 on December 31 ( a )		Number Charts Sampled or EHR Total ( b )		Number of patients with counseling and BMI documented ( c )
12	MEASURE: Children and adolescents aged 3 - 17 during measurement year (on or prior to 31 December) with a BMI percentile, and counseling on nutrition and physical activity documented for the current year

B.1 Patient Zip Codes by Insurance Source

Current Patients by Zip Code Table:

Zip Code	Patients
03301
03302
03303
Other zip codes
Unknown residence
Total

Proposed Patients by Zip Code Table:

Zip Code	None/Uninsured	Medicaid/CHIP/ Other Public	Medicare	Private Insurance
Other
Unknown
03301
03302
03304
.
.
.
03833

B.2 Revised Age Break to Summarize Insurance Source Data

Change in age categories from 0-19 years and 20 years and older to match the Census categories 0-17 years and 18 years and older

Current:

TABLE 4 – SELECTED PATIENT CHARACTERISTICS
Principal Third Party Medical Insurance Source		0-19 years old ( a )	20 and older ( b )
7.	None/ Uninsured
8a.	Regular Medicaid (Title XIX)
8b.	CHIP Medicaid
8.	Total Medicaid (Line 8a + 8b)
9.	Medicare (Title XVIII)
10a.	Other Public Insurance Non-CHIP (specify:)
10b.	Other Public Insurance CHIP
10.	Total Public Insurance (Line 10a + 10b)
11.	Private Insurance
12.	Total (Sum Lines 7 + 8 + 9 +10 +11)

Proposed:

TABLE 4 – SELECTED PATIENT CHARACTERISTICS
Principal Third Party Medical Insurance Source		0-17 YEARS OLD (a )	18 AND OLDER ( b )
7.	None/ Uninsured
8a.	Regular Medicaid (Title XIX)
8b.	CHIP Medicaid
8.	Total Medicaid (Line 8a + 8b)
9.	Medicare (Title XVIII)
10a.	Other Public Insurance Non-CHIP (specify:)
10b.	Other Public Insurance CHIP
10.	Total Public Insurance (Line 10a + 10b)
11.	Private Insurance
12.	Total (Sum Lines 7 + 8 + 9 +10 +11)

1 No table change needed. The number of women reported in line 11 (c) includes those women age 24 to 64 years old who received a Pap test in the past 3 years and those women age 30 to 64 years old who received a Pap test and HPV screen within past 5 years.