Measuring What Matters Allocation, Planning, and Quality Assessment for the Ryan White CARE Act (2004) / Chapter Skim
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7 Findings and Recommendations
7 Findings and Recommendations
Pages 221-234
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From page 221... ...
Although the CARE Act program has been extremely successful, the complexity of the program and the changing HIV epidemic raise challenges with respect to the equitable allocation of resources and the maintenance of highest quality care. During the 2000 reauthorization of the Act, Congress asked the Institute of Medicine (IOM)
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From page 222... ...
These developments, coupled with growing knowledge about disparities between what is possible and what is routinely achieved in many areas of care, led Congress to suggest that the Committee review current knowledge about ways of monitoring the quality of HIV care in the RWCA. The Committee focused on strategies and measures for federal resource allocation, evaluation of grantee applications, and assessments of the quality of care.
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The Committee suggests two ways to improve HIV case reporting for RWCA resource allocation purposes. First, CDC should accept HIV data from all states, including code-based reporting states, into the national HIV/AIDS reporting database.
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Future development of strategies for using data should consider the burden of data collection and reporting and help states and EMAs develop the technical skills and infrastructure necessary to provide standardized, timely information. Despite the many challenges facing the Ryan White CARE Act, it is, in many ways, an extraordinarily successful health care policy.
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Additional resources may be required to implement some of the Committee's recommendations. CHAPTER 4: HIV REPORTING DATA AND TITLE I AND II FORMULAS FINDINGS AND RECOMMENDATIONS Finding 4-1 While the Committee supports Congressional intent to incorpo rate data into the RWCA allocation formulas that reflect the evolving needs of the epidemic, the Committee finds that states' HIV reporting systems are neither ready nor adequate for purposes of RWCA resource allocation.
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Finding 4-6 Several structural features of the Title I and Title II funding for mulas -- most notably the counting of EMA cases in both Titles I and II state formula allocations, but also such measures as hold harmless provisions and set-asides for Emerging Communities -- have a large influence on resulting allocations. Such structural features may dampen the effect of variation in troduced by the addition of HIV cases, and could obviate the potential bene fits of adding HIV cases to the CARE Act allocation formulas.
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The Secretary of HHS should provide CDC with the funding to provide the technical as sistance to states necessary to support the integration of code with name based data into the national HIV reporting database. Because of the im portance of obtaining consistent data from all jurisdictions, the CDC should include HIV reporting data from code-based states and estimate the degree of overcounting due to duplication while procedures and infra structure for definitive unduplication are developed.
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Recommendation 4-4 Prior to future reauthorizations of the CARE Act, the Secretary of HHS should initiate studies to improve the evidence base for understanding how well HIV case reporting and other methods for estimat ing HIV cases reflect the relative burden of disease and the relative resources necessary to respond to those needs in different areas. The Secretary should engage an independent body to estimate the dollar allocations that would result for Title I and II grantees from alternative input data and alternative RWCA allocation formulas.
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Recommendation 5-3 HRSA/HAB should evaluate the feasibility and useful ness of using social area indicator models based on publicly available data that are collected in standardized ways across jurisdictions, to estimate EMA level resource needs for the Title I supplemental award. This approach also might be useful in assessing resource needs for other RWCA discretionary grant programs.
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Measures examining a more complete spectrum of services including, for example, those assessing support services, are important but are not yet in wide enough use to allow for consensus to emerge about specific measures for HIV care. Examples of potential measures of supportive services include the provision of case management, benefits advocacy, or substance abuse and mental health services.
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Standard defini tions and detailed criteria for these measures need to be developed by HRSA in collaboration with grantees, affected communities, and other stakeholders after a rigorous examination of the importance, scientific soundness, and feasibility of potential measures.
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should provide additional resources to HRSA and CDC to develop infrastructure for monitoring quality at the patient, clinic, and population levels. This infrastructure development strategy has three major components: a.
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2000. Ryan White CARE Act: Opportunities to Enhance Funding Equity GAO/T-HEHS-00-150.
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