Attachment B – Instrument: Word Version
Form approved
OMB No. 0920-0879
Expiration date: 03/31/2018
Preventive Health and Health Services Block Grant Assessment
Thank you for participating in the Centers for Disease Control and Prevention’s (CDC’s) assessment of the Preventive Health and Health Services (PHHS) Block Grant. Your participation will help CDC gather important information regarding results and improvements achieved by the PHHS Block Grant from July 1, 2016, through June 30, 2017.
Completing the questionnaire is voluntary and will take approximately 60 minutes.
To advance through the questionnaire, please use the Forward (>>) and Back (<<) buttons located in the lower-right corner of each page. Please note that you do not have to complete the questionnaire in one sitting. The data you enter are automatically saved as you progress to each new section, therefore you may stop and return at a later time if needed. Your response to the questionnaire is due on 10/31/2017.
Throughout the questionnaire, key terms appear in underlined, italicized font. If you hover over a key term with your mouse/pointer, the term’s definition will appear in a text box.
For technical support on completing and submitting the questionnaire, please contact Maggie Carlin ([email protected] / 571-318-5410).
For other questions about this questionnaire, please contact Garry Lowry ([email protected] / 404-498-0361) or Karen Mumford ([email protected] / 404-498-0365).
The findings from this assessment will be used to inform CDC of the outputs and cross-cutting outcomes of the PHHS Block Grant and refine existing measures and/or inform the development of future measures for assessment purposes. No personally identifiable information will be collected. Responses will be kept secure and results will be reported only in aggregate form. Findings will be shared with various stakeholders, including grantees, and might be included in articles and reports that will be made available publicly.
CDC estimates the average public reporting burden for this collection of information as 60 minutes per response, including the time for reviewing instructions, searching existing data/information sources, gathering and maintaining the data/information needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-0879).
Respondent Information
Select your PHHS Block Grant-funded jurisdiction from the drop-down menu. [List of 61 grantees]
Public Health Infrastructure
Public health infrastructure includes the organizational capacity (i.e., the systems, workforce, partnerships, and resources) that enables health departments to perform their core functions and provide essential services. Improvements to infrastructure may occur within the grantee health department, either department-wide or within a specific program, or across the grantee jurisdiction’s public health system.
This section includes questions related to measure 1.1 and measure 1.2, which are focused on two aspects of public health infrastructure respectively: 1) information systems capacity improvement, and 2) quality improvement.
Information Systems Capacity Improved – Measure 1.1
Please answer the following questions related to information systems that were newly developed, improved, and/or maintained through PHHS Block Grant-funded support during the 12-month reporting period.
Have any local organizations or other government agencies in your jurisdiction used PHHS Block Grant funds to support development, improvement, and/or maintenance of one or more information systems?
Yes [DISPLAY Q2a]
No
Not sure
2a. How many local organizations or other government agencies used PHHS Block Grant funds to support development, improvement, and/or maintenance of one or more information systems? Number of local organizations: __________ [OPTIONAL]
Have any health departments in your jurisdiction used PHHS Block Grant funds to support development, improvement, and/or maintenance of one or more information systems?
Yes
No [SKIP to Q6]
3a. What is the total number of information systems that were newly developed, improved, and/or maintained? Number: __________
3b. What is the name/title of the newly developed, improved, and/or maintained information system? __________
3b.1 What system type was newly developed, improved, and/or maintained?
Laboratory data system
Surveillance system
Vital events database (e.g., birth, death, fetal death)
Registry (e.g., cancer registry)
Performance management system
Financial management system
Human capital management system (e.g., human resources, personnel)
Health information exchange (HIE)
Electronic health record (EHR) system
Other information system
3b.2 What type of health department developed, improved, and/or maintained this information system? Select all that apply.
Grantee health department [DISPLAY Q3.1.1.2.a]
Local health department (LHDs)
Tribal health department (THDs)
3b.2a How many health departments used or had access to this system?
Number of LHDs: _____
Number of THDs: _____
Not sure
3b.3 How were PHHS Block Grant funds used to support information system capacity? Select all that apply.
Initiated development of a new system or module
Maintained an existing system or module
Enhanced or expanded an existing system or module
Sustained or restored a system or module
4. How many unique local health departments (LHDs) used PHHS Block Grant funds to support development, improvement, and/or maintenance of one or more information systems? Number of LHDs:
5. How many unique tribal health departments (THDs) used PHHS Block Grant funds to support development, improvement, and/or maintenance of one or more information systems? Number of THDs:
Quality Improved – Measure 1.2
Please answer the following questions related to improvements in the efficiency and/or effectiveness of operations, programs, or services that were achieved through PHHS Block Grant-funded support during the 12-month reporting period.
Have any local organizations or other government agencies in your jurisdiction used PHHS Block Grant funds to support a quality improvement effort focused on the efficiency and/or effectiveness of an operation, program or service?
Yes [DISPLAY Q6a]
No
Not sure
6a. How many local organizations or other government agencies used PHHS Block Grant funds to support a quality improvement effort focused on the efficiency and/or effectiveness of an operation, program, or service? Number of local organizations: __________ [OPTIONAL]
Have any health departments in your jurisdiction used PHHS Block Grant funds to support a quality improvement effort focused on the efficiency and/or effectiveness of an operation, program, or service?
Yes
No [SKIP to Q8]
7a. What type of health department in your jurisdiction used PHHS Block Grant funds to support a quality improvement effort focused on the efficiency and/or effectiveness of an operation, program, or service? Select all that apply.
Grantee health department [DISPLAY Q7b]
Local health department [DISPLAY Q7d]
Tribal health department [DISPLAY Q7e]
7b. What is the total number of operations, programs, or services for which an efficiency and/or effectiveness improvement was achieved by your (grantee) health department using PHHS Block grant-funded support? Number: __________
7c. What is the name/title of the operation, program, or service for which efficiency and/or effectiveness was improved? __________
7c.1 What type of improvement was achieved? Select all that apply.
Efficiency improvement:
Time saved
Reduced number of steps
Costs saved
Costs avoided
Revenue generated due to billable service
Other (please specify): __________
Effectiveness improvement:
Increased staff satisfaction
Organizational design improvements
Quality enhancements of operations, programs, or services
Other (please specify): __________
7c.2 How were PHHS Block Grant funds used to support the improvement(s)? Select all that apply.
Initiated a new effort to improve efficiency and/or effectiveness
Maintained an ongoing effort to improve efficiency and/or effectiveness (i.e., efficiency and/or effectiveness effort was ongoing from previous reporting period, but improvement was achieved during this reporting period)
Enhanced or expanded an existing effort to improve efficiency and/or effectiveness
Sustained or restored an effort to improve efficiency and/or effectiveness
7d. How many local health departments (LHDs) used PHHS Block Grant funds to support a quality improvement effort focused on the efficiency and/or effectiveness of an operation, program, or service? Number of LHDs: __________
7d.1 What is the total number of operations, programs, or services for which an efficiency and/or effectiveness improvement was achieved by a local health department in your jurisdiction using PHHS Block grant-funded support? Number: __________
7d.2 What is the name/title of the operation, program, or service for which efficiency and/or effectiveness was improved? __________
7d.2a What type of improvement was achieved? Select all that apply.
Efficiency improvement:
Time saved
Reduced number of steps
Costs saved
Costs avoided
Revenue generated due to billable service
Other (please specify): __________
Effectiveness improvement:
Increased staff satisfaction
Organizational design improvements
Quality enhancements of operations, programs, or services
Other (please specify): __________
7d.2b How were PHHS Block Grant funds used to support the improvement(s)? Select all that apply.
Initiated a new effort to improve efficiency and/or effectiveness
Maintained an ongoing effort to improve efficiency and/or effectiveness (i.e., efficiency and/or effectiveness effort was ongoing from previous reporting period, but improvement was achieved during this reporting period)
Enhanced or expanded an existing effort to improve efficiency and/or effectiveness
Sustained or restored an effort to improve efficiency and/or effectiveness
7e. How many tribal health departments (THDs) used PHHS Block Grant funds to support a quality improvement effort focused on the efficiency and/or effectiveness of an operation, program, or service? Number THDs: __________
7e.1 What is the total number of operations, programs, or services for which an efficiency and/or effectiveness improvement was achieved by a tribal health department in your jurisdiction using PHHS Block grant-funded support? Number: __________
7e.2 What is the name/title of the operation, program, or service for which efficiency and/or effectiveness was improved? __________
7e.2a What type of improvement was achieved? Select all that apply.
Efficiency improvement:
Time saved
Reduced number of steps
Costs saved
Costs avoided
Revenue generated due to billable service
Other (please specify): __________
Effectiveness improvement:
Increased staff satisfaction
Organizational design improvements
Quality enhancements of operations, programs, or services
Other (please specify): __________
7e.2b How were PHHS Block Grant funds used to support the improvement(s)? Select all that apply.
Initiated a new effort to improve efficiency and/or effectiveness
Maintained an ongoing effort to improve efficiency and/or effectiveness (i.e., efficiency and/or effectiveness effort was ongoing from previous reporting period, but improvement was achieved during this reporting period)
Enhanced or expanded an existing effort to improve efficiency and/or effectiveness
Sustained or restored an effort to improve efficiency and/or effectiveness
7f. Was an established quality improvement method (e.g., Plan-Do-Study-Act, Lean/Six Sigma) used by a health department to achieve any of the improvements in the efficiency and/or effectiveness of an operation, program, or service you have reported on?
Yes [DISPLAY Q7f.1]
No
Not sure
Please provide the following information for one example of an improvement in the efficiency and/or effectiveness of an operation, program, or service for which a deliberate and defined quality improvement method was used by a health department:
7f.1. Name/title of the operation, program, or service: _______________________________________
7f.2. Specific issue being addressed through quality improvement: ______________________________
7f.3. Quality improvement method used: __________________________________________________
7f.4. Brief description of the efficiency and/or effectiveness achieved: ___________________________
To help us learn more about public health infrastructure improvements achieved through PHHS Block Grant-funded support during the 12-month reporting period, please answer the following questions focused on national standards and accreditation.
How did your health department use PHHS Block Grant funds to address national standards or conduct accreditation-related activities as established by the Public Health Accreditation Board (PHAB)? Select all that apply.
PHHS Block Grant funds were not used in this way
Paid for PHAB fees
Hired staff to support accreditation-related activities (e.g., performance improvement manager, accreditation coordinator)
Worked to meet and/or maintain performance against the standards (including prerequisites, key plans, and processes described through the standards)
Provided support to local health department(s) to pay for PHAB fees
Provided support to local health department(s) to hire staff to support accreditation-related activities (e.g., performance improvement manager, accreditation coordinator)
Provided support to local health department(s) to meet and/or maintain performance against the standards
Provided support to tribal health department(s) to pay for PHAB fees
Provided support to tribal health department(s) to hire staff to support accreditation-related activities (e.g., performance improvement manager, accreditation coordinator)
Provided support to tribal health department(s) to meet and/or maintain performance against the standards
Other (please specify): __________
Emerging Needs
Emerging needs are public health issues that are beginning to present themselves as problems within the grantee’s jurisdiction. They can affect the jurisdiction as a whole or specific areas within the jurisdiction, such as counties, tribes, and cities.
This section includes questions related to measure 2.1, which is focused on all types of emerging public health needs.
Emerging Public Health Needs Addressed – Measure 2.1
Please answer the following questions related to emerging public health needs that were addressed through PHHS Block Grant-funded support during the 12-month reporting period.
Have any local organizations or other government agencies in your jurisdiction used PHHS Block Grant funds to support an effort to address an emerging public health need?
Yes
No
Not sure
Have any health departments in your jurisdiction used PHHS Block Grant funds to support an effort to address an emerging public need?
Yes
No [SKIP to Q11]
10a. What is the total number of emerging public health needs that were addressed by health departments in your jurisdiction through PHHS Block Grant-funded support? Number of emerging public health needs: __________
10b. What is the name/title of the emerging public health need that was addressed? __________
10b.1 How would you characterize this emerging public health need? Select all that apply.
Newly developing
Newly prioritized
10b.2 How was this emerging public health need identified? Select all that apply.
Conducted, monitored, or updated a jurisdiction health assessment (e.g., state health assessment)
Conducted a topic- or program-specific assessment (e.g., tobacco assessment, environmental health assessment)
Identified via surveillance systems or other data sources
Prioritized within a strategic plan
Declared as an emergency within your jurisdiction
Governor (or other political leader) established as a priority
Legislature established as a priority
Tribal government/elected official established as a priority
Other (please specify): __________
10b.3 What was the size of the population potentially affected (target population) by this emerging need? Number: __________
10b.4 How were PHHS Block Grant funds used to support the effort to address this emerging public health need? Select all that apply.
Initiated a new effort to address the emerging public health need
Maintained an existing effort to address the emerging public health need
Enhanced or expanded an existing effort to address the emerging public health need
Sustained or restored an effort to address the emerging public health need
Evidence-Based Public Health
Evidence-based public health practice involves implementing effective interventions. It includes both building and using evidence (i.e., data and information) to define public health needs, describe the effectiveness of interventions, and describe effective implementation of interventions.
This section includes questions related to measure 3.1, which is focused on a key aspect of evidence-based public health practice—implementing evidence-based public health interventions.
Evidence-Based Public Health Interventions Implemented – Measure 3.1
Please answer the following questions related to public health interventions that were implemented (i.e., delivered for the first time, ongoing, or completed) through PHHS Block Grant-funded support during the 12-month reporting period.
Have any local organizations or other government agencies in your jurisdiction used PHHS Block Grant funds to support implementation of public health interventions?
Yes [DISPLAY Q11a]
No
Not sure
11a. How many local organizations or other government agencies used PHHS Block Grant funds to support implementation of public health interventions? Number of local organizations: __________ [OPTIONAL]
Have any health departments in your jurisdiction used PHHS Block Grant funds to support implementation of public health interventions?
Yes
No [SKIP to Q13]
12a. What is the total number public health interventions that were implemented by health departments in your jurisdiction through PHHS Block Grant-funded support? Number of public health interventions:___
12b. What is the name/title of the public health intervention that was implemented? __________
12b.1 What type of health department(s) implemented this public health intervention? Select all that apply.
Grantee health department
Local health department
Tribal health department
12b.2 What level of evidence supports this public health intervention? Select only one.
Rigorous evidence: (Rating category 4) – Formal, comprehensive, and systematic review of all relevant literature (i.e., published intervention evaluations or studies that have evidence of effectiveness, feasibility, reach, sustainability, and transferability). Examples of sources of evidence qualifying as rigorous include The Guide to Community Preventive Services, the US Preventive Services Task Force, and systematic reviews published in peer-reviewed journals.
Strong evidence: (Rating category 3) – An informal, non-comprehensive, non-systematic review of some but not all relevant literature (i.e., multiple published evaluations or studies that have evidence of effectiveness, feasibility, reach, sustainability, and transferability). Examples of sources of evidence qualifying as strong include non-systematic reviews published by the federal government and non-systematic reviews published in peer-reviewed journals.
Moderate evidence: (Rating category 2) – At least one published evaluation or study, with peer review, that has evidence of effectiveness, feasibility, reach, sustainability, and transferability. Examples of sources of evidence qualifying as moderate include journal articles of individual studies, published intervention research, and published pilot studies.
Weak evidence: (Rating category 1) – At least one unpublished evaluation or study without peer review, that has evidence of effectiveness, feasibility, reach, sustainability, and transferability. Examples of sources of evidence qualifying as weak include unpublished intervention research, pilot studies, case studies, and field-based summaries. [DISPLAY Q12b.2a-12b.2b]
No evidence: No evaluation or study either peer reviewed or non-peer reviewed, that has evidence of effectiveness, feasibility, reach, sustainability, and transferability. New and/or innovative interventions would most likely have no evidence established. [DISPLAY Q12b.2a-12b.2b]
Not sure
12b.2a Was the public health intervention untested, new, and/or innovative?
Yes
No
Not sure
12b.2b Were data or information collected for the purpose of determining the intervention’s effectiveness at achieving intended outcomes?
Yes
No
Not sure
12c What Healthy People 2020 health topic area(s) was this public health intervention implemented to address? Select one primary health topic area and, if applicable, one secondary health topic area.
Primary Secondary
(Select one) [OPTIONAL]
1-Access to health services
2-Adolescent health
3-Arthritis, osteoporosis, and chronic back conditions
4-Blood disorders and blood safety
5-Cancer
6-Chronic kidney disease
7-Dementias, including Alzheimer’s disease
8-Diabetes
9-Disability and health
10-Early and middle childhood
11-Educational and community-based programs
12-Environmental health
13-Family planning
14-Food safety
15-Genomics
16-Global health
17-Health communication and health information technology
18-Health-related quality of life and well-being
19-Healthcare-associated infections
20-Hearing and other sensory or communication disorders
21-Heart disease and stroke
22-HIV
23-Immunization and infectious diseases
24-Injury and violence prevention
25-Lesbian, gay, bisexual, and transgender health
26-Maternal, infant, and child health
27-Medical product safety
28-Mental health and mental disorders
29-Nutrition and weight status
30-Occupational safety and health
31-Older adults
32-Oral health
33-Physical activity
34-Preparedness
35-Public health infrastructure
36-Respiratory diseases
37-Sexually transmitted diseases
38-Sleep health
39-Social determinants of health
40-Substance abuse
41-Tobacco use
42-Vision
43-Emergency medical services
44-Rape or attempted rape
12d. How were PHHS Block Grant funds used to support implementation of this public health intervention? Select all that apply.
Initiated a new public health intervention
Maintained implementation of an existing public health intervention
Enhanced or expanded an existing public health intervention
Sustained or restored a public health intervention
To help us learn more about evidence-based public health practice implemented through PHHS Block Grant-funded support during the 12-month reporting period, please answer the following questions focused on 1) building the evidence base for public health, and 2) making evidence-based decisions.
How did your health department use PHHS Block Grant funds to support building the evidence base for public health? Select all that apply.
PHHS Block Grant funds were not used in this way
Conducted, monitored, or updated a jurisdiction health assessment (e.g., state health assessment)
Conducted a topic- or program-specific assessment (e.g., tobacco assessment, environmental health assessment)
Analyzed or monitored surveillance or other types of data
Provided support to local health department(s) to conduct, monitor, or update a community health assessment
Provided support to local health department(s) to conduct a topic- or program-specific assessment (e.g., tobacco assessment, environmental health assessment)
Provided support to local health department(s) to analyze or monitor surveillance or other types of data
Provided support to tribal health department(s) to conduct, monitor, or update a tribal health assessment
Provided support to tribal health department(s) to conduct, monitor, or update a community health assessment
Provided support to tribal health department(s) to conduct a topic- or program-specific assessment (e.g., tobacco assessment, environmental health assessment)
Provided support to tribal health department(s) to analyze or monitor surveillance or other types of data
Other (please specify): __________
How did your health department use PHHS Block Grant funds to support evidence-based decision making? Select all that apply.
PHHS Block Grant funds were not used in this way
Developed or updated a jurisdiction’s health improvement plan (e.g., state health improvement plan) based on a jurisdiction health assessment (e.g., state health assessment)
Developed or updated a community health improvement plan based on a community health assessment
Developed or updated a topic- or program-specific action plan
Provided support to local health department(s) for developing or updating a community health improvement plan
Provided support to local health department(s) for developing or updating a topic- or program-specific action plan
Provided support to tribal health department(s) to develop or update a tribal health improvement plan based on a tribal health assessment
Provided support to tribal health department(s) for developing or updating a community health improvement plan
Provided support to tribal health department(s) for developing or updating a topic- or program-specific action plan
Other (please specify): __________
Thank you for taking the time to participate in this assessment of the PHHS Block Grant. Please feel free to provide any feedback about this survey, the process to collect/report the required information, or the measures in general to [email protected]. Please contact Garry Lowry ([email protected] / 404-498-0361) or Karen Mumford ([email protected] / 404-498-0365) if you have any questions.
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Definition of key terms by survey section – for use in “hover over” function
Overall survey
12-month reporting period: July 1, 2016, through June 30, 2017.
PHHS Block Grant-funded support: Use of PHHS Block Grant funds, in any amount, to directly fund, provide staff for, or provide technical assistance to support an activity.
Local organizations: Non-governmental entities within a grantee’s jurisdiction that receive support from the grantee to implement public health efforts in support of communities within that jurisdiction. Types of local organizations include community-based organizations, schools, faith-based organizations, community health centers, and medical clinics.
Other Government Agencies: All official governmental bodies other than state, local, or tribal health departments within a grantee’s jurisdiction that receive support from the grantee to implement public health efforts in support of communities within that jurisdiction. Types of other government agencies include, but are not limited to, the department of education, licensed or certified home care agencies, and criminal justice agencies.
Initiate new public health efforts: Develop and implement new programs, services, and activities that address public health needs that were previously not funded, either due to lack of available funds or an absence of funding allotted to the need.
Maintain existing public health efforts: Support established programs, services, and activities from year to year.
Enhance or expand existing public health efforts: Enhance an effort by refining and improving its quality or expand an effort by adding components or outreach to additional populations.
Sustain public health efforts: Continue an effort without disruptions after original funding for the effort has ended.
Restore public health efforts: Reinstate or rebuild an effort that was significantly disrupted or had ended due to loss of original funding.
Information Systems Capacity Improved
Measure 1.1: Number of state, territorial, tribal, and local health departments whose capacity to collect or enhance data that provide information of public health importance was improved or maintained through the use of PHHS Block Grant funds.
Information systems: Systems that provide the ability to collect, store, protect, process, manage, analyze, use, and communicate information.
Information of public health importance: Any data that provide insight into health, health inequities, contributing factors or causes of health challenges, and/or potential policy, public health, or community solutions. These are data that are needed for the planning, implementation, and evaluation of public health practice.
Quality Improved
Measure 1.2: Number of state, territorial, tribal, and local health departments in which the efficiency or effectiveness of operations, programs, or services was improved through the use of PHHS Block Grant funds.
Costs avoided: Reduction in future costs due to innovations in, or changes to, process or program implementation or service delivery. The difference between the documented costs after implementation of a quality improvement effort and the predicted costs before the effort was implemented.
Costs saved: Reduction in existing costs of completing a process, implementing a program, or delivering a service. The difference between the documented costs after implementation of a quality improvement effort and the costs that occurred before the effort was implemented.
Efficiency and/or effectiveness (i.e., quality improvements): Improvements in programs, operations, or services that result in reductions in the amount of resources required for implementation (i.e., efficiency) or in a greater ability to achieved agency or program goals through improved delivery of programs or services or implementation of organizational processes (i.e., effectiveness).
Public Health Accreditation Board (PHAB): A nonprofit organization dedicated to advancing the continuous quality improvement of tribal, state, local, and territorial public health departments.
Emerging Needs Addressed
Measure 2.1: Number of emerging public health needs that were addressed through the use of PHHS Block Grant funds.
Emerging public health needs: Public health needs within a grantee’s jurisdiction that are newly developing or newly prioritized.
Newly developing: A public health need that is newly arisen; exists, but has developed new characteristics; or re-emerged.
Newly prioritized: A public health need that has been known to the grantee but lacked funding or support; is new to the public health field; or has new expectations for a public health response.
Evidence-Based Public Health Interventions Implemented
Measure 3.1: Number of evidence-based public health interventions implemented through the use of PHHS Block Grant funds.
Build the evidence base for public health: Produce new or strengthen existing data and information that are used to 1) define public health needs and 2) determine the effectiveness of interventions at achieving intended outcomes.
Healthy People 2020 health topic area(s): The 42 health topic areas designated by Healthy People 2020. Note: Two additional categories—“emergency medical services” and “rape or attempted rape”—are included in the Block Grant Management Information System as health topic areas that grantees can select to identify the focus of their work.
Public health intervention(s): Any type of planned activity (e.g., program, service, policy) designed to prevent disease or injury or promote health in a group of people.
Innovative: Incorporating novel, creative thinking around new or existing programs or services.
Evidence-based decision making: The use of data and information to prioritize public health needs and approaches for addressing those public health needs.
5-16-17 PHHS Block Grant Evaluation Survey Page
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | Attachment B - Instrument- Word Version |
| Author | Garry Lowry |
| File Modified | 0000-00-00 |
| File Created | 2021-01-22 |