(DIYA) Bhumkar Chowk Call Girls Just Call 7001035870 [ Cash on Delivery ] Pun...
SHADAC: Overview and Evaluation
1. SHADAC Overview and Evaluation Lynn Blewett, PhD State Health Access Data Assistance Center University of Minnesota, Minneapolis, MN SHAP Grantee Meeting January 14, 2010 Funded by a grant from the Robert Wood Johnson Foundation
4. 4 The SHADAC Vision Bridging the Gap Between Research and Policy
5. 5 What is SHADAC Independent research center located at the University of Minnesota School of Public Health Led by an interdisciplinary team of tenured faculty and supported by research fellows and graduate research assistants Primary funding from Robert Wood Johnson Foundation Additional project-specific funding from CDC, ASPE, CMS, state-specific contracts, etc. New funding from HRSA to provide technical assistance to SHAP grantees
6.
7. 8 State Health Access Reform Evaluation (SHARE) National Program of RWJF Supports evaluation of state health reform initiatives 16 single and multi-study projects covering more than 25 states Wide variety of topics including insurance market reforms, outreach and enrollment initiatives, Medicaid/CHIP expansions Aim to translate this research to inform other states and the national reform debate
8. SHAP Technical Assistance Review grantee evaluation plans Provide advice on outcome indicators, data sources, data availability, and evaluation methods Help states identify data sources for benchmarks Provide technical assistance to grantees in: Selecting appropriate metrics to allow measurement of progress toward objectives Identifying the types and sources of available data Assisting in the use of longitudinal data where feasible Survey assistance (as previously described) Assessing differences between state and federal survey data Resources can be found here: www.shadac.org/shap 9
10. Measuring Health Insurance Coverage Current Population Survey (CPS) American Community Survey (ACS) State-Specific Household Surveys 11
11. Current Population Survey (CPS) Currently the most commonly used survey for estimating uninsurance rates at the state and federal level Nationally representative household based survey Large enough sample for state‐level estimates Added an insurance verification question in 2000, which improved accuracy Used in SCHIP funding formula – this may be changing soon….. 12
12. American Community Survey (ACS) New source of data for health insurance coverage (2008 is first year) Eventually replacing the Decennial Census long form Phone survey, mail and in-person follow up Large enough sample for state‐level and sub‐state estimates Cities, counties, political districts and census tracks 13
13. ACS – Benefits Large sample size 1.94 million households per year in ACS vs. 75,477 households for CPS Ability to drill down to geographic areas Geographic areas with at least 100,000 people in public use file Counties with populations over 65,000 in restricted Census file (smaller counties added later with multi-year avg.) More precision on estimating subpopulations by state e.g. low-income uninsured children Point-in-time health insurance question 14
14. ACS – Initial Concerns Impact of using mail surveys in addition to telephone and in-person interviews Only one health insurance question None on health status, access Disability-related question only Does not include state-specific names for Medicaid and SCHIP No verification question for health insurance coverage 15
15. ACS Question: Is this person CURRENTLY covered by any of the following types of health insurance or health coverage plans? a. Insurance through a current or former employer or union; b. Insurance purchased directly from an insurance company; c. Medicare, for people 65 and older; d. Medicaid, Medical Assistance, or any kind of government-assistance plan for those with low incomes or a disability (e) VA; (f) TRICARE; (g) Indian Health Service 16
16. ACS – Different Data Source, Different Data U.S. Census FactFinder Limited age categories (0-17) More variables including counties over 65,000 http://www.census.gov/acs/www/index.html SHADAC DataCenter uses the Public Use Microdata Age (0-17) or (0-18) uninsurance characteristics State-level only Ease of access but limited variables http://www.shadac.org/datacenter 17
17. ASC - Public Use Microdata Samples (PUMS) Public use microdata sample (PUMS) is 1% of the U.S. population Single-year file for geographic areas with population of 100,000 Counties with populations 65,000 and over are included in the FactFinder PUMS uses a different geographic area called the PUMA - Public Use Microdata Area http://www.census.gov/acs/www/Products/users_guide/index.htm 18
18. Households - ACS vs. CPS Sample Size Comparison 19 Source: U.S. Census Bureau Current Population Survey Annual Social and Economic Supplement, 2008; and 2007 American Community Survey. Sample counts do not include group quarters or vacant housing units.
19. ACS vs CPS - Uninsurance Rates for Adults and Adults <200% FPL 20 Source: U.S. Census Bureau 2008 American Community Survey, Public Use Microdata Sample and CPS-ASEC 2009 Significance test for difference of ACS and CPS * p<.05 **p<.01 ***p<.001
20. ACS vs CPS - Uninsurance Rates for Kids and Kids <200% FPL 21 Source: U.S. Census Bureau 2008 American Community Survey, Public Use Microdata Sample and CPS-ASEC 2009 Significance test for difference of ACS and CPS * p<.05 **p<.01 ***p<.001 (Children = 0 to 18 years of age)
21. What’s a PUMA? Unique geographic areas Required to have a minimum population of 100,000 All PUMA areas exceed the established population threshold (65,000), thus insuring that there will be single-year ACS data for them published each year PUMAs provide more state geographic coverage but may be new to many users 22
22. ACS - Wisconsin Uninsurance Estimates by County for Children 0-17* 23 * Summary tables from American Fact Finder contain only fixed age categories.
23. ACS - Wisconsin Uninsurance Estimates by PUMAfor Children 0-18*, 2008 24 * Analysis using ACS public use microdata allows user-defined age categories.
24. ACS - Wisconsin Uninsurance by PUMAfor Children 0-18 Under 200% FPL, 2008 25
26. Survey Assistance State survey design and implementation Clarify variance between state estimates from different surveys Best way of asking insurance, income, race/ethnicity questions Assistance to states using SHADAC's Coordinated State Coverage Survey (CSCS), a survey tool for estimating insurance coverage rates in states - http://www.shadac.org/content/coordinated-state-coverage-survey-cscs Online library of state survey tools http://www.shadac.org/content/state-survey-research-activity 27
28. 29 Survey Assistance - Strengths of State Survey Data Typically more sample than national data Flexibility in adding policy relevant questions Ability to over-sample and drill down to subpopulations Children, geographic units, race/ethnicity Analysts have data in hand Ability to do analysis in-house Quick turn-around Policy development: Simulation of policy options Program design and development, marketing and outreach
29. 30 Survey Assistance - Weaknesses of State Survey Data Lack of comparability across states Variability in timing of surveys Most are telephone surveys – coverage issues due to large cell-phone coverage Inconsistency in data documentation Cost concerns limits number of variables Discrepancies with other data sources (survey and administrative data)
31. Data Center Online table and chart generator Designed to help health policy analysts build policy-relevant tables of health insurance coverage estimates. Easy to access. Easy to use. Estimates available from three sources CPS, as published by the Census Bureau. CPS, enhanced by SHADAC to account for historical changes in methodology. ACS, as published by the Census Bureau (coming soon). Trended data CPS estimates from survey years 1988 to the present. Easy to export 32
32. Data Center – Available Estimates Health insurance coverage Uninsured, Insured (private, government, and military) Counts, percents, standard error Table options Race/ethnicity Age Poverty Household income Sex Marital status (individual and family) Children in household Work status (individual and family) Education (individual and family) Health status (CPS only) Citizenship (ACS only) 33
33. Data Center - Getting to the Data Center 34 Go towww.shadac.org Click on “Data Center”
35. Evaluation Support - Resources Assistance with developing interview guides, focus group protocols, survey instruments Review of qualitative data analysis strategies Review of logic models Stakeholder analysis Information about available evaluation resources 36
36. Evaluation Support - Plan Review Recommend additions or revisions, Provide advice on outcome indicators Work with grantees to identify data sources Help determine data availability and data-sharing agreement requirements Advise on evaluation methods 37
37. Evaluation Support - Assist with Evaluation Design Assist states in developing an evaluation plan to meet benchmark and reporting requirements Review evaluation plan in relation to policy objectives and access initiatives. Identify areas that are not aligned and other gaps in the evaluation plan, including identifying existing data and data still needing to be collected. 38
39. Selection Criteria Responsive to the needs of HRSA Common data are available for all SHAP states allowing a fairly standard comparison of outcomes Measures are consistent with the existing grantee evaluation plans and not require additional resources 40
40. Benchmarks Rates of health insurance coverage for target populations Generated from the American Community Survey (ACS) and CPS Program enrollment of target populations and previous insurance status if possible Program costs Illustration of funding from all sources 41 SHADAC will work with states on these benchmarks and other evaluation needs
42. Data Acquisition Successful evaluations depend on good data Data acquisition within and across agencies and between entities can be difficult and time consuming HIPAA and IRB process can stall process Include data agreements in contracts, legislation and discuss early in the process Seek [or consider obtaining] legal review and input on state-specific data sharing and data privacy laws 43
43. Evaluation Timing Many important evaluation measures will only come in year 2 and year 3 of the grant Think of ways to track early progress through process measures or interim outcome measures Determine implementation milestones and document these to show progress 44
44. Mid-Course Changes Program implementation and evaluation results should be interconnected Share evaluation results across the project team Use results from the evaluation to inform ongoing project changes, improvements 45
45. Discussion Questions Describe top 3 SHAP plan objectives Define target populations Discuss 2-3 components of evaluation (hopefully related to #1 and #2) Identify challenges – those you have encountered or those you anticipate 46
![Overview About SHADAC Measuring Health Insurance ,[object Object],Data Center Evaluation Support HRSA Benchmark Areas Strategic Considerations 2](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)