# 1 {#section .Chapter# .unnumbered}

# Access to Quality Health Services

#### Clinical Preventive Care

1-1 Persons with health insurance

1-2 Health insurance coverage for clinical preventive services

1-3 Counseling about health behaviors

1-3a Physical activity or exercise

1-3b Diet and nutrition

1-3c Smoking cessation

1-3d Reduced alcohol consumption

1-3e Childhood injury prevention: vehicle restraints and bicycle helmets

1-3f Unintended pregnancy

1-3g Prevention of sexually transmitted diseases

1-3h Management of menopause

#### Primary Care

1-4 Source of ongoing care

1-4a All ages

1-4b Children and youth aged 17 years and under

1-4c Adults aged 18 years and older

1-5 Usual primary care provider

1-6 Difficulties or delays in obtaining needed health care

1-7 Core competencies in health provider training

1-8 Racial and ethnic representation in health professions

1-8a American Indian or Alaska Native---Health professions

1-8b Asian or Pacific Islander---Health professions

1-8c Black or African American---Health professions

1-8d Hispanic or Latino---Health professions

1-8e American Indian or Alaska Native---Nursing

1-8f Asian or Pacific Islander---Nursing

1-8g Black or African American---Nursing

1-8h Hispanic or Latino---Nursing

1-8i American Indian or Alaska Native---Medicine

1-8j Asian or Pacific Islander---Medicine

1-8k Black or African American---Medicine

1-8l Hispanic or Latino---Medicine

1-8m American Indian or Alaska Native---Dentistry

1-8n Asian or Pacific Islander---Dentistry

1-8o Black or African American---Dentistry

1-8p Hispanic or Latino---Dentistry

1-8q American Indian or Alaska Native---Pharmacy

1-8r Asian or Pacific Islander---Pharmacy

1-8s Black or African American---Pharmacy

1-8t Hispanic or Latino---Pharmacy

1-9 Hospitalization for ambulatory-care-sensitive conditions

1-9a Pediatric asthma

1-9b Uncontrolled diabetes

1-9c Immunization-preventable pneumonia or influenza

#### Emergency Services

1-10 Delay or difficulty in getting emergency care

1-11 Rapid prehospital emergency care

1-12 Single toll-free number for poison control centers

1-13 Trauma care systems

1-14 Special needs of children

1-14a Online medical direction

1-14b Guidelines

#### Long-Term Care and Rehabilitative Services

1-15 Long-term care services

1-16 Pressure ulcers among nursing home residents

### Clinical Preventive Care {#clinical-preventive-care-1 .Heading3Inside}

  ---------------------- --------------------------------------------------------------------------------------------
  1-1. Increase the      
  proportion of persons  
  with health\           
  insurance.             

  **National Data        National Health Interview Survey (NHIS), CDC, NCHS.
  Source**               

  **State Data Source**  Behavioral Risk Factor Surveillance System (BRFSS), CDC, NCCDPHP.

  **Healthy People 2000  Adapted from 21.4 (Clinical Preventive Services).
  Objective**            

  **Leading Health       Access to Health Care.
  Indicator**            

  **Measure**            Percent (age adjusted---see Comments).

  **Baseline**           83 (1997).

  **Numerator**          Number persons under age 65 years who report coverage by any type of public or private
                         health insurance.

  **Denominator**        Number of persons under age 65 years.

  **Population           U.S. civilian, noninstitutionalized population.
  Targeted**             

  **Questions Used To    For questions from the 1997 National Health Interview Survey, Family core, Section IV,
  Obtain the National    Health Insurance, see:
  Data**                 ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Survey_Questionnaires/NHIS/1997/qfamilyx.pdf.

  **Expected             Annual.
  Periodicity**          

  **Comments**           Health care coverage includes any type of health insurance or health care plan, including
                         those obtained by employment, direct purchase, and Government programs, including Medicare,
                         Medi-Gap, military healthcare/VA, Medicaid, CHAMPUS/TRICARE/CHAMP-VA, Indian Health Service,
                         State-sponsored health plans, or other public hospital or physician programs.

                         More information on the definition of health insurance coverage is provided by *Health,
                         United States, 2000*.**^1^**

                         Data are age adjusted to the 2000 standard population. Age-adjusted percents are weighted
                         sums of age-specific percents. For a discussion on age adjustment, see Part A, section 5.

                         This measure is a modification of its comparable Healthy People 2000 objective 21.4, which
                         proposed to improve the financing and delivery of clinical preventive services. Healthy
                         People 2000 objective 21.4 was tracked by a proxy measure: the proportion of persons with no
                         health care coverage.**^2^** This objective tracks the converse measure, the proportion of
                         persons with health care coverage and does not specifically address delivery of clinical
                         preventive services (see objective 1-2). Also, this objective is age adjusted; the Healthy
                         People 2000 objective was not.

                         This objective is one of the measures used to track the Access to Health Care Leading Health
                         Indicator. See Appendix H for a complete listing.

                         See Part C for a description of NHIS and BRFSS and Appendix A for focus area contact
                         information.
  ---------------------- --------------------------------------------------------------------------------------------

  

  ----------------------- -----------------------------------------------
  1-2. (Developmental)    
  Increase the proportion 
  of insured\             
  persons with coverage   
  for clinical preventive 
  services.               

  **Comments**            An operational definition could not be
                          specified at the time of publication.

                          The proposed data source is the Medical
                          Expenditure Panel Survey (MEPS), AHRQ (formerly
                          AHCPR). The 1996 MEPS data are currently being
                          analyzed and may provide baseline data on
                          percent of persons with coverage for selected
                          preventive services (well-child visits,
                          immunizations, mammograms, cervical cancer
                          screening, and adult physicals).

                          The numerator will be the number of persons who
                          have coverage for clinical preventive services
                          as part of their health insurance. The
                          denominator will be the number of insured
                          persons.

                          These data are based on an abstract of the
                          respondents' insurance policies, rather than
                          household reports.

                          This objective is a modification of Healthy
                          People 2000 objective 21.4, which proposed to
                          improve the financing and delivery of clinical
                          preventive services (see Comments provided with
                          objective 1-1 for more information).

                          Data will be collected periodically, with as
                          much as a 3-year lag time in reporting these
                          data.

                          Data that are collected periodically from
                          policy booklets obtained from MEPS household
                          respondents could be modified to collect
                          information on a broader set of preventive
                          services. Recommended services to track include
                          childhood and adult immunizations; recommended
                          cancer screening (breast, cervix, and colon);
                          smoking cessation counseling; and contraceptive
                          services.

                          See Part C for a description of MEPS and
                          Appendix A for focus area contact information.
  ----------------------- -----------------------------------------------

  

1-3. Increase the proportion of persons appropriately counseled about
health behaviors.

  ----------------------- -----------------------------------------------
  1-3a. (Developmental)   
  Physical activity or    
  exercise (adults aged   
  18 years and older).    

  **Comments**            An operational definition could not be
                          specified at time of publication.

                          The proposed national data source is the
                          National Health Interview Survey (NHIS), CDC,
                          NCHS.

                          The proposed State data source is the
                          Behavioral Risk Factor Surveillance System
                          (BRFSS), CDC, NCCDPHP.

                          This objective is a modification of Healthy
                          People 2000 objective 1.12, which tracked the
                          proportion of clinicians who counseled 81 to
                          100 percent of their patients about physical
                          activity and was tracked using the Primary Care
                          Providers Surveys, OPHS, ODPHP, and the
                          Prevention in Primary Care Study, American
                          College of Preventive Medicine. This measure
                          will track adults aged 18 years and older with
                          a physician visit in the past year and is
                          scheduled to be tracked using NHIS, CDC, NCHS.

                          The proposed questions to be used to obtain the
                          data are scheduled for inclusion in the 2001
                          NHIS.

                          See Part C for a description of NHIS and
                          Appendix A for focus area contact information.
  ----------------------- -----------------------------------------------

  

  ----------------------- -----------------------------------------------
  1-3b. (Developmental)   
  Diet and nutrition      
  (adults aged 18 years   
  and older).             

  **Comments**            An operational definition could not be
                          specified at time of publication.

                          The proposed national data source is the
                          National Health Interview Survey (NHIS), CDC,
                          NCHS.

                          The proposed State data source is the
                          Behavioral Risk Factor Surveillance System
                          (BRFSS), CDC, NCCDPHP.

                          This objective is a modification of Healthy
                          People 2000 objective 2.21, which tracked the
                          proportion of clinicians who counseled 81 to
                          100 percent of their patients about nutrition
                          and diet; it was tracked using the Primary Care
                          Providers Surveys, OPHS, ODPHP and the
                          Prevention in Primary Care Study, American
                          College of Preventive Medicine. This measure
                          will track adults aged 18 years and older with
                          a physician visit in the past year, who
                          received counseling on diet and nutrition; the
                          measure is scheduled to be tracked using the
                          National Health Interview Survey, CDC, NCHS.

                          The proposed questions to be used to obtain the
                          data are scheduled for inclusion in the 2001
                          NHIS.

                          See Part C for a description of NHIS and
                          Appendix A for focus area contact information.
  ----------------------- -----------------------------------------------

-    

  ----------------------- -----------------------------------------------
  1-3c. (Developmental)   
  Smoking cessation       
  (adult smokers aged 18  
  years and older).       

  **Comments**            An operational definition could not be
                          specified at time of publication.

                          The proposed national data source is the
                          National Health Interview Survey (NHIS), CDC,
                          NCHS.

                          The proposed State data source is the
                          Behavioral Risk Factor Surveillance System
                          (BRFSS), CDC, NCCDPHP.

                          This objective is a modification of Healthy
                          People 2000 objective 3.16, which tracked the
                          proportion of clinicians who counseled 81 to
                          100 percent of their patients about smoking
                          cessation, and was tracked using the Primary
                          Care Providers Surveys, OPHS, ODPHP and the
                          Prevention in Primary Care Study, American
                          College of Preventive Medicine. This measure
                          will track adults aged 18 years and older with
                          a physician visit in the past year who are
                          current smokers or who have quit smoking in the
                          past 12 months; the measure is scheduled to be
                          tracked using the National Health Interview
                          Survey, CDC, NCHS.

                          The proposed questions to be used to obtain the
                          data are scheduled for inclusion in the 2001
                          NHIS.

                          See Part C for a description of NHIS and
                          Appendix A for focus area contact information.
  ----------------------- -----------------------------------------------

  

+----------------------+-----------------------------------------------+
| 1-3d.                |                                               |
| (Developmental)      |                                               |
| Reduced alcohol      |                                               |
| consumption (adults  |                                               |
| aged 18 years and    |                                               |
| older with excessive |                                               |
| alcohol              |                                               |
| consumption).        |                                               |
+----------------------+-----------------------------------------------+
| **Comments**         | An operational definition could not be        |
|                      | specified at time of publication.             |
+----------------------+-----------------------------------------------+
|                      | The proposed national data source is the      |
|                      | National Health Interview Survey (NHIS), CDC, |
|                      | NCHS.                                         |
+----------------------+-----------------------------------------------+
|                      | The proposed State data source is the         |
|                      | Behavioral Risk Factor Surveillance System    |
|                      | (BRFSS), CDC, NCCDPHP.                        |
+----------------------+-----------------------------------------------+
|                      | This objective is a modification of Healthy   |
|                      | People 2000 objective 4.19, which tracked the |
|                      | proportion of clinicians who counseled 81 to  |
|                      | 100 percent of their patients about drug and  |
|                      | alcohol use; it was tracked using the Primary |
|                      | Care Providers Surveys, OPHS, ODPHP and the   |
|                      | Prevention in Primary Care Study, American    |
|                      | College of Preventive Medicine. This measure  |
|                      | will track adults aged 18 years and older     |
|                      | with a physician visit in the past year who   |
|                      | have reported excessive alcohol consumption;  |
|                      | the measure is scheduled to be tracked using  |
|                      | the National Health Interview Survey, CDC,    |
|                      | NCHS.                                         |
+----------------------+-----------------------------------------------+
|                      | The proposed questions to be used to obtain   |
|                      | the data are scheduled for inclusion in the   |
|                      | 2001 NHIS.                                    |
+----------------------+-----------------------------------------------+
|                      | See Part C for a description of NHIS and      |
|                      | Appendix A for focus area contact             |
|                      | information.                                  |
+----------------------+-----------------------------------------------+
|                   |                                               |
|                      |                                               |
| 1-3e.                |                                               |
| (Developmental)      |                                               |
| Childhood injury     |                                               |
| prevention: vehicle\ |                                               |
| restraints and       |                                               |
| bicycle helmets      |                                               |
| (children aged 17    |                                               |
| years and\           |                                               |
| under).              |                                               |
+----------------------+-----------------------------------------------+
| **Comments**         | An operational definition could not be        |
|                      | specified at time of publication.             |
+----------------------+-----------------------------------------------+
|                      | The proposed national data source is the      |
|                      | National Health Interview Survey (NHIS), CDC, |
|                      | NCHS.                                         |
+----------------------+-----------------------------------------------+
|                      | The proposed State data source is the         |
|                      | Behavioral Risk Factor Surveillance System    |
|                      | (BRFSS), CDC, NCCDPHP.                        |
+----------------------+-----------------------------------------------+
|                      | This objective is a modification of Healthy   |
|                      | People 2000 objective 9.21, which tracked the |
|                      | proportion of clinicians who counseled 81 to  |
|                      | 100 percent of their patients about injury    |
|                      | prevention; the objective was tracked using   |
|                      | the Primary Care Providers Surveys, OPHS,     |
|                      | ODPHP and the Prevention in Primary Care      |
|                      | Study, American College of Preventive         |
|                      | Medicine. This measure will track children    |
|                      | aged 17 years and under who are reported to   |
|                      | have had a physician visit in the past year   |
|                      | and received counseling on the use of vehicle |
|                      | restraints and bicycle helmets, using the     |
|                      | National Health Interview Survey, CDC, NCHS.  |
+----------------------+-----------------------------------------------+
|                      | The proposed questions to be used to obtain   |
|                      | the data are scheduled for inclusion in the   |
|                      | 2001 NHIS.                                    |
+----------------------+-----------------------------------------------+
|                      | See Part C for a description of NHIS and      |
|                      | Appendix A for focus area contact             |
|                      | information.                                  |
+----------------------+-----------------------------------------------+

  

+----------------------+-----------------------------------------------+
| 1-3f. Unintended     |                                               |
| pregnancy (females   |                                               |
| aged 15 to 44        |                                               |
| years).              |                                               |
+----------------------+-----------------------------------------------+
| **National Data      | National Survey on Family Growth (NSFG), CDC, |
| Source**             | NCHS.                                         |
+----------------------+-----------------------------------------------+
| **State Data         | Not identified.                               |
| Source**             |                                               |
+----------------------+-----------------------------------------------+
| **Healthy People     | Adapted from 14.12 (Maternal and Infant       |
| 2000 Objective**     | Health) (also 5.10).                          |
+----------------------+-----------------------------------------------+
| **Measure**          | Percent.                                      |
+----------------------+-----------------------------------------------+
| **Baseline**         | 19 (1995).                                    |
+----------------------+-----------------------------------------------+
| **Numerator**        | Number of women aged 15 to 44 years with a    |
|                      | physician visit in the past 12 months who     |
|                      | received counseling on either birth control   |
|                      | or getting sterilized.                        |
+----------------------+-----------------------------------------------+
| **Denominator**      | Number of women aged 15 to 44 years with a    |
|                      | physician visit in the past 12 months.        |
+----------------------+-----------------------------------------------+
| **Population         | U.S. civilian, noninstitutionalized           |
| Targeted**           | population.                                   |
+----------------------+-----------------------------------------------+
| **Questions Used To  | From the 1995 National Survey on Family       |
| Obtain the National  | Growth:                                       |
| Data**               |                                               |
+----------------------+-----------------------------------------------+
|                      | -   In the past 12 months, that is since      |
|                      |     ([month/year]{.underline}), have you      |
|                      |     received any of the following birth       |
|                      |     control services from a doctor or other   |
|                      |     health care provider?                     |
|                      |                                               |
|                      |     Counseling about birth control or a       |
|                      |     prescription for a method?\               |
|                      |     Counseling about getting sterilized?      |
+----------------------+-----------------------------------------------+
| **Expected           | Periodic.                                     |
| Periodicity**        |                                               |
+----------------------+-----------------------------------------------+
| **Comments**         | Women were considered to receive counseling   |
|                      | if they responded "yes" to either receiving   |
|                      | counseling about birth control or getting     |
|                      | sterilized.                                   |
|                      |                                               |
|                      | This objective is a modification of Healthy   |
|                      | People 2000 objective 14.12, which tracked    |
|                      | the proportion of clinicians who counseled 81 |
|                      | to 100 percent of their patients about family |
|                      | planning; it was tracked using the Primary    |
|                      | Care Providers Surveys, OPHS, ODPHP and the   |
|                      | Prevention in Primary Care Study, American    |
|                      | College of Preventive Medicine.               |
+----------------------+-----------------------------------------------+
|                      | See Part C for a description of NSFG and      |
|                      | Appendix A for focus area contact             |
|                      | information.                                  |
+----------------------+-----------------------------------------------+

  

  ----------------------- -----------------------------------------------
  1-3g. (Developmental)   
  Prevention of sexually  
  transmitted diseases    
  (males aged 15 to 49    
  years, females aged 15  
  to 44 years).           

  **Comments**            An operational definition could not be
                          specified at time of publication.

                          The proposed national data source is the
                          National Survey on Family Growth (NSFG), CDC,
                          NCHS.

                          This objective is a modification of Healthy
                          People 2000 objective 18.9 (also 19.14), which
                          tracked the proportion of clinicians who
                          counseled 81 to 100 percent of their patients
                          about prevention of HIV and other sexually
                          transmitted diseases; the objective was tracked
                          using the Primary Care Providers Surveys, OPHS,
                          ODPHP and the Prevention in Primary Care Study,
                          American College of Preventive Medicine.

                          The 2001 NSFG will collect data on STD
                          counseling for men aged 15 to 49 years. While
                          the NSFG does collect data on family planning
                          services for women aged 15 to 44 years
                          \[including the receipt of birth control
                          services (including condoms)\], specific
                          questions on STD counseling among women
                          currently are not included.

                          See Part C for a description of NSFG and
                          Appendix A for focus area contact information.
  ----------------------- -----------------------------------------------

-    

  ----------------------- -----------------------------------------------
  1-3h. (Developmental)   
  Management of menopause 
  (females aged 46 to 56  
  years).                 

  **Comments**            An operational definition could not be
                          specified at time of publication.

                          The proposed national data source is the
                          National Health Interview Survey (NHIS), CDC,
                          NCHS. The proposed State data source is the
                          Behavioral Risk Factor Surveillance System
                          (BRFSS), CDC, NCCDPHP.

                          This measure is a modification of Healthy
                          People 2000 objective 17.18, which tracked the
                          proportion of perimenopausal women aged 40 to
                          60 years who were counseled about estrogen
                          replacement therapy. This measure will track
                          women aged 46 to 56 years who have had a
                          physician visit in the past year and report
                          that they have received counseling on
                          management of menopause.

                          The proposed questions to be used to obtain the
                          data are scheduled for inclusion in the 2001
                          NHIS.

                          See Part C for a description of NHIS and
                          Appendix A for focus area contact information.
  ----------------------- -----------------------------------------------

  

### Primary Care

1-4. Increase the proportion of persons who have a specific source of
ongoing care.

1-4a. All ages.

+----------------------+-----------------------------------------------+
| **National Data      | National Health Interview Survey (NHIS), CDC, |
| Source**             | NCHS.                                         |
+----------------------+-----------------------------------------------+
| **State Data         | Not identified.                               |
| Source**             |                                               |
+----------------------+-----------------------------------------------+
| **Healthy People     | Adapted from 21.3 (Clinical Preventive        |
| 2000 Objective**     | Services), age adjusted to the 2000 standard  |
|                      | population.                                   |
+----------------------+-----------------------------------------------+
| **Leading Health     | Access to Health Care.                        |
| Indicator**          |                                               |
+----------------------+-----------------------------------------------+
| **Measure**          | Percent (age adjusted---see Comments).        |
+----------------------+-----------------------------------------------+
| **Baseline**         | 87 (1998).                                    |
+----------------------+-----------------------------------------------+
| **Numerator**        | Number of persons who report having a         |
|                      | specific source of primary care.              |
+----------------------+-----------------------------------------------+
| **Denominator**      | Number of persons.                            |
+----------------------+-----------------------------------------------+
| **Population         | U.S. civilian, noninstitutionalized           |
| Targeted**           | population.                                   |
+----------------------+-----------------------------------------------+
| **Questions Used To  | From the 1998 National Health Interview       |
| Obtain the National  | Survey:                                       |
| Data**               |                                               |
+----------------------+-----------------------------------------------+
|                      | -   Is there a place that you usually go when |
|                      |     you are sick or need advice about your    |
|                      |     health?                                   |
+----------------------+-----------------------------------------------+
|                      | -   What kind of place is it: a clinic,       |
|                      |     doctor's office, emergency room, or some  |
|                      |     other place?                              |
|                      |                                               |
|                      |     \(a\) Hospital emergency room\            |
|                      |     (b) Urgent care/walk-in clinic\           |
|                      |     (c) Doctor's office\                      |
|                      |     (d) Clinic\                               |
|                      |     (e) Health center facility\               |
|                      |     (f) Hospital outpatient clinic\           |
|                      |     (g) HMO (Health Maintenance               |
|                      |     Organization)/\                           |
|                      |     Pre-paid group\                           |
|                      |     (h) Military or other VA healthcare\      |
|                      |     (i) Some other place                      |
+----------------------+-----------------------------------------------+
| **Expected           | Annual.                                       |
| Periodicity**        |                                               |
+----------------------+-----------------------------------------------+
| **Comments**         | A specific source of primary care includes    |
|                      | responses (b) through (i) listed above. A     |
|                      | hospital emergency room (a) is not included   |
|                      | as a specific source of primary care.         |
+----------------------+-----------------------------------------------+
|                      | Data are age adjusted to the 2000 standard    |
|                      | population. Age-adjusted percents are         |
|                      | weighted sums of age-specific percents. For a |
|                      | discussion on age adjustment, see Part A,     |
|                      | section 5.                                    |
+----------------------+-----------------------------------------------+
|                      | This measure is modified from its comparable  |
|                      | Healthy People 2000 objective 21.3, which     |
|                      | tracked persons aged 18 years and older. This |
|                      | measure tracks persons of all ages and is age |
|                      | adjusted to the 2000 standard population.     |
+----------------------+-----------------------------------------------+
|                      | This objective is one of the measures used to |
|                      | track the Access to Health Care Leading       |
|                      | Health Indicator. See Appendix H for a        |
|                      | complete listing.                             |
+----------------------+-----------------------------------------------+
|                      | See Part C for a description of NHIS and      |
|                      | Appendix A for focus area contact             |
|                      | information.                                  |
+----------------------+-----------------------------------------------+

  

1-4b. Children and youth aged 17 years and under.

  ----------------------- -----------------------------------------------
  **National Data         National Health Interview Survey (NHIS), CDC,
  Source**                NCHS.

  **State Data Source**   Not identified.

  **Healthy People 2000   Adapted from 21.3 (Clinical Preventive
  Objective**             Services).

  **Measure**             Percent (age adjusted---see Comments).

  **Baseline**            93 (1998).

  **Numerator**           Number of children and youth aged 17 years and
                          under who report having a specific source of
                          primary care.

  **Denominator**         Number of children and youth aged 17 years and
                          under.

  **Population Targeted** U.S. civilian, noninstitutionalized population.

  **Questions Used To     See Questions Used To Obtain the National Data
  Obtain the National     provided with objective 1-4a.
  Data**                  

  **Expected              Annual.
  Periodicity**           

  **Comments**            A specific source of primary care includes
                          responses (b) through (i) listed in the
                          Questions Used To Obtain the National Data
                          provided with objective 1-4a, above. A hospital
                          emergency room (a) is not included as a
                          specific source of primary care.

                          Data are age adjusted to the 2000 standard
                          population. Age-adjusted percents are weighted
                          sums of age-specific percents. For a discussion
                          on age adjustment, see Part A, section 5.

                          This measure is modified from its comparable
                          Healthy People 2000 objective 21.3, which
                          tracked persons aged 18 years and older. This
                          measure tracks children and youth aged 17 years
                          and under and is age adjusted to the 2000
                          standard population.

                          See Part C for a description of NHIS and
                          Appendix A for focus area contact information.
  ----------------------- -----------------------------------------------

  

1-4c. Adults aged 18 years and older.

  -----------------------------------------------------------------------
  **National Data         National Health Interview Survey (NHIS), CDC,
  Source**                NCHS.
  ----------------------- -----------------------------------------------
  **State Data Source**   Behavioral Risk Factor Surveillance System
                          (BRFSS), CDC, NCCDPHP.

  **Healthy People 2000   21.3 (Clinical Preventive Services), age
  Objective**             adjusted to the 2000 standard population.

  **Measure**             Percent (age adjusted---see Comments).

  **Baseline**            85 (1998).

  **Numerator**           Number adults aged 18 years and older who
                          report having a specific source of primary
                          care.

  **Denominator**         Number of adults aged 18 years and older.

  **Population Targeted** U.S. civilian, noninstitutionalized population.

  **Questions Used To     See Questions Used To Obtain the National Data
  Obtain the National     provided with objective 1-4a.
  Data**                  

  **Expected              Annual.
  Periodicity**           

  **Comments**            A specific source of primary care includes
                          responses (b) through (i) listed in the
                          Questions Used To Obtain the National Data
                          provided with objective 1-4a above. A hospital
                          emergency room (a) is not included as a
                          specific source of primary care.

                          Data are age adjusted to the 2000 standard
                          population. Age-adjusted percents are weighted
                          sums of age-specific percents. For a discussion
                          on age adjustment, see Part A, section 5.

                          See Part C for a description of NHIS and BRFSS,
                          and Appendix A for focus area contact
                          information.
  -----------------------------------------------------------------------

  

+----------------------+-----------------------------------------------+
| 1-5. Increase the    |                                               |
| proportion of        |                                               |
| persons with a usual |                                               |
| primary care         |                                               |
| provider.            |                                               |
+----------------------+-----------------------------------------------+
| **National Data      | Medical Expenditure Panel Survey (MEPS), AHRQ |
| Source**             | (formerly AHCPR).                             |
+----------------------+-----------------------------------------------+
| **State Data         | Not identified.                               |
| Source**             |                                               |
+----------------------+-----------------------------------------------+
| **Healthy People     | Not applicable.                               |
| 2000 Objective**     |                                               |
+----------------------+-----------------------------------------------+
| **Measure**          | Percent.                                      |
+----------------------+-----------------------------------------------+
| **Baseline**         | 77 (1996).                                    |
+----------------------+-----------------------------------------------+
| **Numerator**        | Number of persons who report that they have a |
|                      | usual primary care provider.                  |
+----------------------+-----------------------------------------------+
| **Denominator**      | Number of persons.                            |
+----------------------+-----------------------------------------------+
| **Population         | U.S. civilian, noninstitutionalized           |
| Targeted**           | population.                                   |
+----------------------+-----------------------------------------------+
| **Questions Used To  | From the 1996 Medical Expenditure Panel       |
| Obtain the National  | Survey:                                       |
| Data**               |                                               |
+----------------------+-----------------------------------------------+
|                      | -   Is there a particular doctor's office,    |
|                      |     health center, or other place that        |
|                      |     ([Person]{.underline}) usually goes if    |
|                      |     ([Person]{.underline}) is sick or needs   |
|                      |     advice about ([Person]{.underline})'s     |
|                      |     health?                                   |
+----------------------+-----------------------------------------------+
|                      | -   Is ([Provider]{.underline}) the           |
|                      |     (person/place) they would go for new      |
|                      |     health problems?                          |
+----------------------+-----------------------------------------------+
|                      | -   Is ([Provider]{.underline}) the           |
|                      |     (person/place) they would go for          |
|                      |     preventive health care, such as general   |
|                      |     checkups, examinations, and               |
|                      |     immunizations?                            |
+----------------------+-----------------------------------------------+
|                      | -   Is ([Provider]{.underline}) the           |
|                      |     (person/place) they would go for          |
|                      |     referrals to other health professionals   |
|                      |     when needed?                              |
+----------------------+-----------------------------------------------+
| **Expected           | Annual.                                       |
| Periodicity**        |                                               |
+----------------------+-----------------------------------------------+
| **Comments**         | Persons were determined to have a usual       |
|                      | primary care provider if they reported that   |
|                      | they would usually go to the same health      |
|                      | professional for [all]{.underline} four of    |
|                      | the following situations: if they were sick   |
|                      | or needed advice about their health; if they  |
|                      | had new health problems; if they needed       |
|                      | preventive care such as general checkups,     |
|                      | examinations, and immunizations; and if they  |
|                      | needed referrals to other health              |
|                      | professionals. Persons who reported an        |
|                      | emergency room as their usual source of care  |
|                      | were classified as not having a usual primary |
|                      | care provider.                                |
+----------------------+-----------------------------------------------+
|                      | See Part C for a description of MEPS and      |
|                      | Appendix A for focus area contact             |
|                      | information.                                  |
+----------------------+-----------------------------------------------+

  

+----------------------+-----------------------------------------------+
| 1-6. Reduce the      |                                               |
| proportion of        |                                               |
| families that        |                                               |
| experience\          |                                               |
| difficulties or      |                                               |
| delays in obtaining  |                                               |
| health care or do    |                                               |
| not receive needed   |                                               |
| care for one or more |                                               |
| family members.      |                                               |
+----------------------+-----------------------------------------------+
| **National Data      | Medical Expenditure Panel Survey (MEPS), AHRQ |
| Source**             | (formerly AHCPR).                             |
+----------------------+-----------------------------------------------+
| **State Data         | Not identified.                               |
| Source**             |                                               |
+----------------------+-----------------------------------------------+
| **Healthy People     | Not applicable.                               |
| 2000 Objective**     |                                               |
+----------------------+-----------------------------------------------+
| **Measure**          | Percent.                                      |
+----------------------+-----------------------------------------------+
| **Baseline**         | 12 (1996).                                    |
+----------------------+-----------------------------------------------+
| **Numerator**        | Number of families that report that at least  |
|                      | one family member had difficulty or delay in  |
|                      | obtaining health care or did not receive      |
|                      | needed care.                                  |
+----------------------+-----------------------------------------------+
| **Denominator**      | Number of families.                           |
+----------------------+-----------------------------------------------+
| **Population         | U.S. civilian, noninstitutionalized           |
| Targeted**           | population.                                   |
+----------------------+-----------------------------------------------+
| **Questions Used To  | From the 1996 Medical Expenditure Panel       |
| Obtain the National  | Survey:                                       |
| Data**               |                                               |
+----------------------+-----------------------------------------------+
|                      | -   In the last 12 months, did anyone in the  |
|                      |     family experience difficulty in obtaining |
|                      |     any type of health care, delay in         |
|                      |     obtaining care, or not receive health     |
|                      |     care they thought they needed due to any  |
|                      |     of the reasons listed below?              |
|                      |                                               |
|                      |     \(1\) Couldn't afford care\               |
|                      |     (2) Insurance company wouldn\'t approve,  |
|                      |     cover, or pay for care\                   |
|                      |     (3) Pre-existing condition\               |
|                      |     (4) Insurance required a referral, but    |
|                      |     couldn\'t get one\                        |
|                      |     (5) Doctor refused to accept family\'s    |
|                      |     insurance plan\                           |
|                      |     (6) Medical care too far away\            |
|                      |     (7) Can\'t drive/don\'t have car/ no      |
|                      |     public transportation available\          |
|                      |     (8) Too expensive to get there\           |
|                      |     (9) Hearing impairment or loss\           |
|                      |     (10) Different language\                  |
|                      |     (11) Hard to get into building\           |
|                      |     (12) Hard to get around inside building\  |
|                      |     (13) No appropriate equipment in office\  |
|                      |     (14) Couldn\'t get time off work\         |
|                      |     (15) Didn\'t know where to go to get      |
|                      |     care\                                     |
|                      |     (16) Was refused services\                |
|                      |     (17) Couldn\'t get child care\            |
|                      |     (18) Didn\'t have time or took too long\  |
|                      |     (19) Other                                |
+----------------------+-----------------------------------------------+
| **Expected           | Annual.                                       |
| Periodicity**        |                                               |
+----------------------+-----------------------------------------------+
| **Comments**         | A family is considered having difficulty in   |
|                      | obtaining care if the head of household       |
|                      | responds "yes" to any of the options (1       |
|                      | through 19) listed in the question above.     |
+----------------------+-----------------------------------------------+
|                      | See Part C for a description of MEPS and      |
|                      | Appendix A for focus area contact             |
|                      | information.                                  |
+----------------------+-----------------------------------------------+

  

1-7. (Developmental) Increase the proportion of schools of medicine,
schools of nursing, and other health professional training schools whose
basic curriculum for health care providers includes the core
competencies in health promotion and disease prevention.

  ----------------------- -----------------------------------------------
  **Comments**            An operational definition could not be
                          specified at the time of publication.

                          The proposed national data source is the
                          Adaptation of the Prevention Self-Assessment
                          Analysis, ATPM.

                          See Appendix A for focus area contact
                          information.
  ----------------------- -----------------------------------------------

  

1-8. In the health professions, allied and associated health\
profession fields, and the nursing field, increase the\
proportion of all degrees awarded to members of underrepresented racial
and ethnic groups.

1-8a. American Indian or Alaska Native---health professions and allied
and associated health profession fields.

+----------------------+-----------------------------------------------+
| **National Data      | Survey of Predoctoral Dental Educational      |
| Sources**            | Institutions, American Dental Association;    |
|                      | Profile of Pharmacy Students, American        |
|                      | Association of Colleges of Pharmacy; *AAMC    |
|                      | Data Book*, Association of American Medical   |
|                      | Colleges; Annual Data Report, Association of  |
|                      | Schools of Public Health.                     |
+----------------------+-----------------------------------------------+
| **State Data         | Survey of Predoctoral Dental Educational      |
| Sources**            | Institutions, American Dental Association;    |
|                      | Profile of Pharmacy Students, American        |
|                      | Association of Colleges of Pharmacy; *AAMC    |
|                      | Data Book*, Association of American Medical   |
|                      | Colleges; Annual Data Report, Association of  |
|                      | Schools of Public Health.                     |
+----------------------+-----------------------------------------------+
| **Healthy People     | 21.8 (Clinical Preventive Services).          |
| 2000 Objective**     |                                               |
+----------------------+-----------------------------------------------+
| **Measure**          | Percent.                                      |
+----------------------+-----------------------------------------------+
| **Baseline**         | 0.6 (1996--97).                               |
+----------------------+-----------------------------------------------+
| **Numerator**        | Number of degrees in the health professions   |
|                      | (medicine, dentistry, pharmacy, and public    |
|                      | health) and allied and associated health      |
|                      | profession fields awarded to American Indian  |
|                      | or Alaska Native persons.                     |
+----------------------+-----------------------------------------------+
| **Denominator**      | Number of degrees awarded by accredited       |
|                      | schools to all persons in the health          |
|                      | professions and allied and associated health  |
|                      | profession fields.                            |
+----------------------+-----------------------------------------------+
| **Population         | Students in accredited health professions and |
| Targeted**           | allied and associated health profession       |
|                      | schools.                                      |
+----------------------+-----------------------------------------------+
| **Questions Used To  | Not applicable for data collected on pharmacy |
| Obtain the National  | degrees and public health degrees.            |
| Data**               |                                               |
|                      | For medical degrees, see *AAMC Data           |
|                      | Book*.**^2^**                                 |
|                      |                                               |
|                      | For dental degrees, from the 1997--98 Survey  |
|                      | of Predoctoral Dental Education Institutions: |
+----------------------+-----------------------------------------------+
|                      | -   How many students received a D.D.S. or    |
|                      |     D.M.D. degree between October 1, 1996 and |
|                      |     September 30, 1997?\                      |
|                      |     (Total must equal the total number of     |
|                      |     graduates listed on the graduate class    |
|                      |     list.)                                    |
+----------------------+-----------------------------------------------+
|                      | -   How many students received a D.D.S. or    |
|                      |     D.M.D. degree between October 1, 1996 and |
|                      |     September 30, 1997 in each of the         |
|                      |     following race/ethnicity categories?      |
|                      |                                               |
|                      |     Male Female Total                         |
|                      |                                               |
|                      |     a\. White \_\_\_\_\_ \_\_\_\_\_           |
|                      |     \_\_\_\_\_\                               |
|                      |     b. Black \_\_\_\_\_ \_\_\_\_\_            |
|                      |     \_\_\_\_\_\                               |
|                      |     c. Hispanic \_\_\_\_\_ \_\_\_\_\_         |
|                      |     \_\_\_\_\_\                               |
|                      |     d. Native American \_\_\_\_\_ \_\_\_\_\_  |
|                      |     \_\_\_\_\_\                               |
|                      |     e. Asian \_\_\_\_\_ \_\_\_\_\_            |
|                      |     \_\_\_\_\_\                               |
|                      |     f. Not Indicated \_\_\_\_\_ \_\_\_\_\_    |
|                      |     \_\_\_\_\_\                               |
|                      |     Total \_\_\_\_\_\                         |
|                      |     (Total must equal the total number of     |
|                      |     graduates listed on the graduate class    |
|                      |     list.)                                    |
+----------------------+-----------------------------------------------+
| **Expected           | Annual.                                       |
| Periodicity**        |                                               |
+----------------------+-----------------------------------------------+
| **Comments**         | This measure includes only U.S. citizens in   |
|                      | its tabulation of public health               |
|                      | degrees.**^3^** Dental degrees include both   |
|                      | D.D.S. and D.M.D.**^4^** Pharmacy degrees     |
|                      | include both doctor of pharmacy degrees       |
|                      | awarded as the first professional degree and  |
|                      | postbaccalaureate degrees.**^5^** Medical     |
|                      | degrees include only M.D. graduates.**^2^**   |
+----------------------+-----------------------------------------------+
|                      | This measure combines data from four sources  |
|                      | that collect data on accredited schools; the  |
|                      | data are tabulated by the Bureau of Health    |
|                      | Professions (BHPr), HRSA.                     |
+----------------------+-----------------------------------------------+
|                      | See Appendix A for focus area contact         |
|                      | information.                                  |
+----------------------+-----------------------------------------------+

  

1-8b. Asian or Pacific Islander---health professions and allied and
associated health profession fields.

  -----------------------------------------------------------------------
  **National Data         Survey of Predoctoral Dental Educational
  Sources**               Institutions, American Dental Association;
                          Profile of Pharmacy Students, American
                          Association of Colleges of Pharmacy; *AAMC Data
                          Book*, Association of American Medical
                          Colleges; Annual Data Report, Association of
                          Schools of Public Health.
  ----------------------- -----------------------------------------------
  **State Data Sources**  Survey of Predoctoral Dental Educational
                          Institutions, American Dental Association;
                          Profile of Pharmacy Students, American
                          Association of Colleges of Pharmacy; *AAMC Data
                          Book*, Association of American Medical
                          Colleges; Annual Data Report, Association of
                          Schools of Public Health.

  **Healthy People 2000   21.8 (Clinical Preventive Services).
  Objective**             

  **Measure**             Percent.

  **Baseline**            16.2 (1996--97).

  **Numerator**           Number of degrees in the health professions
                          (medicine, dentistry, pharmacy, and public
                          health) and allied and associated health
                          profession fields awarded to Asian and Pacific
                          Islander persons.

  **Denominator**         Number of degrees awarded by accredited schools
                          to all persons in the health professions and
                          allied and associated health profession fields.

  **Population Targeted** Students in accredited health professions and
                          allied and associated health profession
                          schools.

  **Questions Used To     See Questions Used To Obtain the National Data
  Obtain the National     provided with objective 1-8a.
  Data**                  

  **Expected              Annual.
  Periodicity**           

  **Comments**            See Comments provided with objective 1-8a for
                          more information.
  -----------------------------------------------------------------------

  

1-8c. Black or African American---health professions and allied and
associated health profession fields.

  -----------------------------------------------------------------------
  **National Data         Survey of Predoctoral Dental Educational
  Sources**               Institutions, American Dental Association;
                          Profile of Pharmacy Students, American
                          Association of Colleges of Pharmacy; *AAMC Data
                          Book*, Association of American Medical
                          Colleges; Annual Data Report, Association of
                          Schools of Public Health.
  ----------------------- -----------------------------------------------
  **State Data Sources**  Survey of Predoctoral Dental Educational
                          Institutions, American Dental Association;
                          Profile of Pharmacy Students, American
                          Association of Colleges of Pharmacy; *AAMC Data
                          Book*, Association of American Medical
                          Colleges; Annual Data Report, Association of
                          Schools of Public Health.

  **Healthy People 2000   21.8 (Clinical Preventive Services).
  Objective**             

  **Measure**             Percent.

  **Baseline**            6.7 (1996--97).

  **Numerator**           Number of degrees in the health professions
                          (medicine, dentistry, pharmacy, and public
                          health) and allied and associated health
                          profession fields awarded to black or African
                          American persons.

  **Denominator**         Number of degrees awarded by accredited schools
                          to all persons in the health profession and
                          allied and associated health profession fields.

  **Population Targeted** Students in accredited health professions and
                          allied and associated health profession
                          schools.

  **Questions Used To     See Questions Used To Obtain the National Data
  Obtain the National     provided with objective 1-8a.
  Data**                  

  **Expected              Annual.
  Periodicity**           

  **Comments**            See Comments provided with objective 1-8a for
                          more information.
  -----------------------------------------------------------------------

  

1-8d. Hispanic or Latino---health professions and allied and associated
health profession fields.

  -----------------------------------------------------------------------
  **National Data         Survey of Predoctoral Dental Educational
  Sources**               Institutions, American Dental Association;
                          Profile of Pharmacy Students, American
                          Association of Colleges of Pharmacy; *AAMC Data
                          Book*, Association of American Medical
                          Colleges; Annual Data Report, Association of
                          Schools of Public Health.
  ----------------------- -----------------------------------------------
  **State Data Sources**  Survey of Predoctoral Dental Educational
                          Institutions, American Dental Association;
                          Profile of Pharmacy Students, American
                          Association of Colleges of Pharmacy; *AAMC Data
                          Book*, Association of American Medical
                          Colleges; Annual Data Report, Association of
                          Schools of Public Health.

  **Healthy People 2000   21.8 (Clinical Preventive Services).
  Objective**             

  **Measure**             Percent.

  **Baseline**            4.0 (1996--97).

  **Numerator**           Number of degrees in the health professions
                          (medicine, dentistry, pharmacy, and public
                          health) and allied and associated health
                          profession fields awarded to black or African
                          American persons.

  **Denominator**         Number of degrees awarded by accredited schools
                          to all persons in the health professions and
                          allied and associated health profession fields.

  **Population Targeted** Students in accredited health professions and
                          allied and associated health profession
                          schools.

  **Questions Used To     See Questions Used To Obtain the National Data
  Obtain the National     provided with objective 1-8a.
  Data**                  

  **Expected              Annual.
  Periodicity**           

  **Comments**            See Comments provided with objective 1-8a for
                          more information.
  -----------------------------------------------------------------------

  

1-8e. American Indian or Alaska Native---nursing.

+----------------------+-----------------------------------------------+
| **National Data      | Annual Survey of RN (Registered Nurse)        |
| Source**             | Programs, National League for Nursing, Center |
|                      | for Research in Nursing Education and         |
|                      | Community Health.                             |
+======================+===============================================+
| **State Data         | Annual Survey of RN (Registered Nurse)        |
| Source**             | Programs, National League for Nursing, Center |
|                      | for Research in Nursing Education and         |
|                      | Community Health.                             |
+----------------------+-----------------------------------------------+
| **Healthy People     | Adapted from 21.8a (Clinical Preventive       |
| 2000 Objective**     | Services).                                    |
+----------------------+-----------------------------------------------+
| **Measure**          | Percent.                                      |
+----------------------+-----------------------------------------------+
| **Baseline**         | 0.7 (1995--96).                               |
+----------------------+-----------------------------------------------+
| **Numerator**        | Number of degrees in nursing awarded by       |
|                      | accredited schools to American Indian or      |
|                      | Alaska Native persons.                        |
+----------------------+-----------------------------------------------+
| **Denominator**      | Number of degrees awarded by accredited       |
|                      | schools to all persons in nursing.            |
+----------------------+-----------------------------------------------+
| **Population         | Students in accredited nursing schools.       |
| Targeted**           |                                               |
+----------------------+-----------------------------------------------+
| **Questions Used To  | From the 1999 Annual Survey of RN (Registered |
| Obtain the National  | Nurse) Programs:                              |
| Data**               |                                               |
+----------------------+-----------------------------------------------+
|                      | -   Total Enrollments                         |
|                      |                                               |
|                      |     Ethnic/Racial distribution (all           |
|                      |     students):\                               |
|                      |     \_\_\_\_\_\_ American Indian/Alaskan      |
|                      |     Native\                                   |
|                      |     \_\_\_\_\_\_ Asian/Pacific Islander\      |
|                      |     \_\_\_\_\_\_ Black, Non-Hispanic\         |
|                      |     \_\_\_\_\_\_ Hispanic\                    |
|                      |     \_\_\_\_\_\_ White, Non-Hispanic\         |
|                      |     \_\_\_\_\_\_ Unknown\                     |
|                      |     (The total of the numbers above should    |
|                      |     equal the total enrollment.)              |
+----------------------+-----------------------------------------------+
|                      | -   Total Graduations                         |
|                      |                                               |
|                      |     Ethnic/Racial distribution (number):\     |
|                      |     \_\_\_\_\_\_ American Indian/Alaskan      |
|                      |     Native\                                   |
|                      |     \_\_\_\_\_\_ Asian/Pacific Islander\      |
|                      |     \_\_\_\_\_\_ Black, Non-Hispanic\         |
|                      |     \_\_\_\_\_\_ Hispanic\                    |
|                      |     \_\_\_\_\_\_ White, Non-Hispanic\         |
|                      |     \_\_\_\_\_\_ Unknown\                     |
|                      |     (The total of the numbers above should    |
|                      |     equal the total graduations.)             |
+----------------------+-----------------------------------------------+
| **Expected           | Annual.                                       |
| Periodicity**        |                                               |
+----------------------+-----------------------------------------------+
| **Comments**         | Nursing degrees in basic nursing education    |
|                      | include diploma, associates degree, and basic |
|                      | baccalaure- ate degree.**^6^** Data exclude   |
|                      | degrees awarded to stu- dents in American     |
|                      | Samoa, Guam, and Puerto Rico.                 |
+----------------------+-----------------------------------------------+
|                      | This measure is modified from its comparable  |
|                      | Healthy People 2000 objective 21.8a, which    |
|                      | tracked the number of people enrolled in      |
|                      | schools of nursing. This measure tracks the   |
|                      | degrees awarded by nursing schools to         |
|                      | unrepresented racial and ethnic minority      |
|                      | groups.                                       |
+----------------------+-----------------------------------------------+
|                      | See Appendix A for focus area contact         |
|                      | information.                                  |
+----------------------+-----------------------------------------------+

  

1-8f. Asian or Pacific Islander---nursing.

  -----------------------------------------------------------------------
  **National Data         Annual Survey of RN (Registered Nurse)
  Source**                Programs, National League for Nursing, Center
                          for Research in Nursing Education and Community
                          Health.
  ----------------------- -----------------------------------------------
  **State Data Source**   Annual Survey of RN (Registered Nurse)
                          Programs, National League for Nursing, Center
                          for Research in Nursing Education and Community
                          Health.

  **Healthy People 2000   Adapted from 21.8a (Clinical Preventive
  Objective**             Services).

  **Measure**             Percent.

  **Baseline**            3.2 (1995--96).

  **Numerator**           Number of degrees in nursing awarded by
                          accredited schools to Asian or Pacific Islander
                          persons.

  **Denominator**         Number of degrees awarded by accredited schools
                          to all persons in nursing.

  **Population Targeted** Students in accredited nursing schools.

  **Questions Used To     See Questions Used To Obtain the National Data
  Obtain the National     provided with objective 1-8e.
  Data**                  

  **Expected              Annual.
  Periodicity**           

  **Comments**            See Comments provided with objective 1-8e for
                          more information.
  -----------------------------------------------------------------------

  

1-8g. Black or African American---nursing.

  -----------------------------------------------------------------------
  **National Data         Annual Survey of RN (Registered Nurse)
  Source**                Programs, National League for Nursing, Center
                          for Research in Nursing Education and Community
                          Health.
  ----------------------- -----------------------------------------------
  **State Data Source**   Annual Survey of RN (Registered Nurse)
                          Programs, National League for Nursing, Center
                          for Research in Nursing Education and Community
                          Health.

  **Healthy People 2000   Adapted from 21.8a (Clinical Preventive
  Objective**             Services).

  **Measure**             Percent.

  **Baseline**            6.9 (1995--96).

  **Numerator**           Number of degrees in nursing awarded by
                          accredited schools to black or African American
                          persons.

  **Denominator**         Number of degrees awarded by accredited schools
                          to all persons in nursing.

  **Population Targeted** Students in accredited nursing schools.

  **Questions Used To     See Questions Used To Obtain the National Data
  Obtain the National     provided with objective 1-8e.
  Data**                  

  **Expected              Annual.
  Periodicity**           

  **Comments**            See Comments provided with objective 1-8e for
                          more information.
  -----------------------------------------------------------------------

  

1-8h. Hispanic or Latino---nursing.

  -----------------------------------------------------------------------
  **National Data         Annual Survey of RN (Registered Nurse)
  Source**                Programs, National League for Nursing, Center
                          for Research in Nursing Education and Community
                          Health.
  ----------------------- -----------------------------------------------
  **State Data Source**   Annual Survey of RN (Registered Nurse)
                          Programs, National League for Nursing, Center
                          for Research in Nursing Education and Community
                          Health.

  **Healthy People 2000   Adapted from 21.8a (Clinical Preventive
  Objective**             Services).

  **Measure**             Percent.

  **Baseline**            3.4 (1995--96).

  **Numerator**           Number of degrees in nursing awarded by
                          accredited schools to Hispanic or Latino
                          persons.

  **Denominator**         Number of degrees awarded by accredited schools
                          to all persons in nursing.

  **Population Targeted** Students in accredited nursing schools.

  **Questions Used To     See Questions Used To Obtain the National Data
  Obtain the National     provided with objective 1-8e.
  Data**                  

  **Expected              Annual.
  Periodicity**           

  **Comments**            See Comments provided with objective 1-8e for
                          more information.
  -----------------------------------------------------------------------

  

1-8i. American Indian or Alaska Native---medicine.

  -----------------------------------------------------------------------
  **National Data         *AAMC Data Book*, Association of American
  Source**                Medical Colleges.
  ----------------------- -----------------------------------------------
  **State Data Source**   Not identified.

  **Healthy People 2000   Adapted from 21.8 (Clinical Preventive
  Objective**             Services).

  **Measure**             Percent.

  **Baseline**            0.6 (1996--97).

  **Numerator**           Number of degrees awarded by accredited
                          allopathic medical schools to American Indian
                          or Alaska Native persons.

  **Denominator**         Number of degrees awarded by accredited
                          allopathic medical schools to all persons.

  **Population Targeted** Students in accredited allopathic medical
                          schools.

  **Questions Used To     See *AAMC Data Book*.**^2^**
  Obtain the National     
  Data**                  

  **Expected              Annual.
  Periodicity**           

  **Comments**            Data are obtained through annual surveys
                          completed by accredited medical schools and are
                          aggregate counts of the number of graduates
                          with an M.D. degree.**^2^**

                          This objective is a modification of the Healthy
                          People 2000 objective 21.8, which tracked the
                          proportion of degrees awarded in all health
                          professions (medicine, pharmacy, dentistry, and
                          public health). This measure tracks the
                          proportion of degrees awarded in medicine only.

                          See Appendix A for focus area contact
                          information.
  -----------------------------------------------------------------------

  

1-8j. Asian or Pacific Islander---medicine.

  -----------------------------------------------------------------------
  **National Data         *AAMC Data Book*, Association of American
  Source**                Medical Colleges.
  ----------------------- -----------------------------------------------
  **State Data Source**   Not identified.

  **Healthy People 2000   Adapted from 21.8 (Clinical Preventive
  Objective**             Services).

  **Measure**             Percent.

  **Baseline**            15.9 (1996--97).

  **Numerator**           Number of degrees awarded by accredited
                          allopathic medical schools to Asian or Pacific
                          Islander persons.

  **Denominator**         Number of degrees awarded by accredited
                          allopathic medical schools to all persons.

  **Population Targeted** Students in accredited allopathic medical
                          schools.

  **Questions Used To     See *AAMC Data Book*.**^2^**
  Obtain the National     
  Data**                  

  **Expected              Annual.
  Periodicity**           

  **Comments**            See Comments provided with objective 1-8i for
                          more information.
  -----------------------------------------------------------------------

  

1-8k. Black or African American---medicine.

  ----------------------- -----------------------------------------------
  **National Data         *AAMC Data Book*, Association of American
  Source**                Medical Colleges.

  **State Data Source**   Not identified.

  **Healthy People 2000   Adapted from 21.8 (Clinical Preventive
  Objective**             Services).

  **Measure**             Percent.

  **Baseline**            7.3 (1996--97).

  **Numerator**           Number of degrees awarded by accredited
                          allopathic medical schools to black or African
                          American persons.

  **Denominator**         Number of degrees awarded by accredited
                          allopathic medical schools to all persons.

  **Population Targeted** Students in accredited allopathic medical
                          schools.

  **Questions Used To     See *AAMC Data Book*.**^2^**
  Obtain the National     
  Data**                  

  **Expected              Annual.
  Periodicity**           

  **Comments**            See Comments provided with objective 1-8i for
                          more information.
  ----------------------- -----------------------------------------------

  

1-8l. Hispanic or Latino---medicine.

  -----------------------------------------------------------------------
  **National Data         *AAMC Data Book*, Association of American
  Source**                Medical Colleges.
  ----------------------- -----------------------------------------------
  **State Data Source**   Not identified.

  **Healthy People 2000   Adapted from 21.8 (Clinical Preventive
  Objective**             Services).

  **Measure**             Percent.

  **Baseline**            4.6 (1996--97).

  **Numerator**           Number of degrees awarded by accredited
                          allopathic medical schools to Hispanic or
                          Latino persons.

  **Denominator**         Number of degrees awarded by accredited
                          allopathic medical schools to all persons.

  **Population Targeted** Students in accredited allopathic medical
                          schools.

  **Questions Used To     See *AAMC Data Book*.**^2^**
  Obtain the National     
  Data**                  

  **Expected              Annual.
  Periodicity**           

  **Comments**            See Comments provided with objective 1-8i for
                          more information.
  -----------------------------------------------------------------------

  

1-8m. American Indian or Alaska Native---dentistry.

+----------------------+-----------------------------------------------+
| **National Data      | Survey of Predoctoral Dental Educational      |
| Source**             | Institutions, American Dental Association.    |
+======================+===============================================+
| **State Data         | Survey of Predoctoral Dental Educational      |
| Source**             | Institutions, American Dental Association.    |
+----------------------+-----------------------------------------------+
| **Healthy People     | Adapted from 21.8 (Clinical Preventive        |
| 2000 Objective**     | Services).                                    |
+----------------------+-----------------------------------------------+
| **Measure**          | Percent.                                      |
+----------------------+-----------------------------------------------+
| **Baseline**         | 0.5 (1996--97).                               |
+----------------------+-----------------------------------------------+
| **Numerator**        | Number of degrees from accredited dental      |
|                      | schools awarded to American Indian or Alaska  |
|                      | Native persons.                               |
+----------------------+-----------------------------------------------+
| **Denominator**      | Number of degrees from accredited dental      |
|                      | schools awarded to all persons.               |
+----------------------+-----------------------------------------------+
| **Population         | Students in accredited dental schools.        |
| Targeted**           |                                               |
+----------------------+-----------------------------------------------+
| **Questions Used To  | From the 1997--98 Survey of Predoctoral       |
| Obtain the National  | Dental Educational Institutions:              |
| Data**               |                                               |
+----------------------+-----------------------------------------------+
|                      | -   How many students received a D.D.S. or    |
|                      |     D.M.D. degree between October 1, 1996 and |
|                      |     September 30, 1997?\                      |
|                      |     (Total must equal the total number of     |
|                      |     graduates listed on the graduate class    |
|                      |     list.)                                    |
+----------------------+-----------------------------------------------+
|                      | -   How many students received a D.D.S. or    |
|                      |     D.M.D. degree between October 1, 1996 and |
|                      |     September 30, 1997 in each of the         |
|                      |     following race/ethnicity categories?      |
|                      |                                               |
|                      |     Male Female Total                         |
|                      |                                               |
|                      |     a\. White \_\_\_\_\_ \_\_\_\_\_           |
|                      |     \_\_\_\_\_\                               |
|                      |     b. Black \_\_\_\_\_ \_\_\_\_\_            |
|                      |     \_\_\_\_\_\                               |
|                      |     c. Hispanic \_\_\_\_\_ \_\_\_\_\_         |
|                      |     \_\_\_\_\_\                               |
|                      |     d. Native American \_\_\_\_\_ \_\_\_\_\_  |
|                      |     \_\_\_\_\_\                               |
|                      |     e. Asian \_\_\_\_\_ \_\_\_\_\_            |
|                      |     \_\_\_\_\_\                               |
|                      |     f. Not Indicated \_\_\_\_\_ \_\_\_\_\_    |
|                      |     \_\_\_\_\_\                               |
|                      |     Total \_\_\_\_\_\                         |
|                      |     (Total must equal the total number of     |
|                      |     graduates listed on the graduate class    |
|                      |     list.)                                    |
+----------------------+-----------------------------------------------+
| **Expected           | Annual.                                       |
| Periodicity**        |                                               |
+----------------------+-----------------------------------------------+
| **Comments**         | Dental degrees include both D.D.S. and        |
|                      | D.M.D.**^4^**                                 |
+----------------------+-----------------------------------------------+
|                      | This objective is a modification of the       |
|                      | Healthy People 2000 objective 21.8, which     |
|                      | tracked the proportion of degrees awarded in  |
|                      | all health professions (medicine, pharmacy,   |
|                      | dentistry, and public health). This measure   |
|                      | tracks the proportion of degrees awarded in   |
|                      | dentistry only.                               |
+----------------------+-----------------------------------------------+
|                      | See Appendix A for focus area contact         |
|                      | information.                                  |
+----------------------+-----------------------------------------------+

  

1-8n. Asian or Pacific Islander---dentistry.

  -----------------------------------------------------------------------
  **National Data         Survey of Predoctoral Dental Educational
  Source**                Institutions, American Dental Association.
  ----------------------- -----------------------------------------------
  **State Data Source**   Survey of Predoctoral Dental Educational
                          Institutions, American Dental Association.

  **Healthy People 2000   Adapted from 21.8 (Clinical Preventive
  Objective**             Services).

  **Measure**             Percent.

  **Baseline**            19.5 (1996--97).

  **Numerator**           Number of degrees from accredited dental
                          schools awarded to Asian or Pacific Islander
                          persons.

  **Denominator**         Number of degrees from accredited dental
                          schools awarded to all persons.

  **Population Targeted** Students in accredited dental schools.

  **Questions Used To     See Questions Used To Obtain the National Data
  Obtain the National     provided with objective 1-8m.
  Data**                  

  **Expected              Annual.
  Periodicity**           

  **Comments**            See Comments provided with objective 1-8m for
                          more information.
  -----------------------------------------------------------------------

  

**1-8o. Black or African American---dentistry.**

  -----------------------------------------------------------------------
  **National Data         Survey of Predoctoral Dental Educational
  Source**                Institutions, American Dental Association.
  ----------------------- -----------------------------------------------
  **State Data Source**   Survey of Predoctoral Dental Educational
                          Institutions, American Dental Association.

  **Healthy People 2000   Adapted from 21.8 (Clinical Preventive
  Objective**             Services).

  **Measure**             Percent.

  **Baseline**            5.1 (1996--97).

  **Numerator**           Number of degrees from accredited dental
                          schools awarded to black or African American
                          persons.

  **Denominator**         Number of degrees from accredited dental
                          schools awarded to all persons.

  **Population Targeted** Students in accredited dental schools.

  **Questions Used To     See Questions Used To Obtain the National Data
  Obtain the National     provided with objective 1-8m.
  Data**                  

  **Expected              Annual.
  Periodicity**           

  **Comments**            See Comments provided with objective 1-8m for
                          more information.
  -----------------------------------------------------------------------

  

1-8p. Hispanic or Latino---dentistry.

  -----------------------------------------------------------------------
  **National Data         Survey of Predoctoral Dental Educational
  Source**                Institutions, American Dental Association.
  ----------------------- -----------------------------------------------
  **State Data Source**   Survey of Predoctoral Dental Educational
                          Institutions, American Dental Association.

  **Healthy People 2000   Adapted from 21.8 (Clinical Preventive
  Objective**             Services).

  **Measure**             Percent.

  **Baseline**            4.7 (1996--97).

  **Numerator**           Number of degrees from accredited dental
                          schools awarded to Hispanic or Latino persons.

  **Denominator**         Number of degrees from accredited dental
                          schools awarded to all persons.

  **Population Targeted** Students in accredited dental schools.

  **Questions Used To     See Questions Used To Obtain the National Data
  Obtain the National     provided with objective 1-8m.
  Data**                  

  **Expected              Annual.
  Periodicity**           

  **Comments**            See Comments provided with objective 1-8m for
                          more information.
  -----------------------------------------------------------------------

  

1-8q. American Indian or Alaska Native---pharmacy.

  -----------------------------------------------------------------------
  **National Data         Profile of Pharmacy Students, American
  Source**                Association of Colleges of Pharmacy.
  ----------------------- -----------------------------------------------
  **State Data Source**   Profile of Pharmacy Students, American
                          Association of Colleges of Pharmacy.

  **Healthy People 2000   Adapted from 21.8 (Clinical Preventive
  Objective**             Services).

  **Measure**             Percent.

  **Baseline**            0.4 (1996--97)

  **Numerator**           Number of degrees awarded by accredited
                          pharmacy schools to American Indian or Alaska
                          Native persons.

  **Denominator**         Number of degrees awarded by accredited
                          pharmacy schools to all persons.

  **Population Targeted** Students in accredited pharmacy schools.

  **Questions Used To     Not applicable.
  Obtain the National     
  Data**                  

  **Expected              Annual.
  Periodicity**           

  **Comments**            Pharmacy degrees include both doctor of
                          pharmacy degrees awarded as the first
                          professional degree and postbaccalaureate
                          degrees.**^5^**

                          This objective is a modification of the Healthy
                          People 2000 objective 21.8, which tracked the
                          proportion of degrees awarded in all health
                          professions (medicine, pharmacy, dentistry, and
                          public health). This measure tracks the
                          proportion of degrees awarded in pharmacy only.

                          See Appendix A for focus area contact
                          information.
  -----------------------------------------------------------------------

  

1-8r. Asian or Pacific Islander---pharmacy.

  -----------------------------------------------------------------------
  **National Data         Profile of Pharmacy Students, American
  Source**                Association of Colleges of Pharmacy.
  ----------------------- -----------------------------------------------
  **State Data Source**   Profile of Pharmacy Students, American
                          Association of Colleges of Pharmacy.

  **Healthy People 2000   Adapted from 21.8 (Clinical Preventive
  Objective**             Services).

  **Measure**             Percent.

  **Baseline**            17.5 (1996--97).

  **Numerator**           Number of degrees awarded by accredited
                          pharmacy schools to Asian or Pacific Islander
                          persons.

  **Denominator**         Number of degrees awarded by accredited
                          pharmacy schools to all persons.

  **Population Targeted** Students in accredited pharmacy schools.

  **Questions Used To     Not applicable.
  Obtain the National     
  Data**                  

  **Expected              Annual.
  Periodicity**           

  **Comments**            See Comments provided with objective 1-8q for
                          more information.
  -----------------------------------------------------------------------

  

###### 1-8s. Black or African American---pharmacy. {#s.-black-or-african-americanpharmacy. .Heading6THP}

+----------------------+-----------------------------------------------+
| ####                 | Profile of Pharmacy Students, American        |
| ## National Data Sou | Association of Colleges of Pharmacy.          |
| rce {#national-data- |                                               |
| source .Heading6THP} |                                               |
+======================+===============================================+
| **State Data         | Profile of Pharmacy Students, American        |
| Source**             | Association of Colleges of Pharmacy.          |
+----------------------+-----------------------------------------------+
| **Healthy People     | Adapted from 21.8 (Clinical Preventive        |
| 2000 Objective**     | Services).                                    |
+----------------------+-----------------------------------------------+
| **Measure**          | Percent.                                      |
+----------------------+-----------------------------------------------+
| **Baseline**         | 5.7 (1996--97).                               |
+----------------------+-----------------------------------------------+
| **Numerator**        | Number of degrees awarded by accredited       |
|                      | pharmacy schools to black or African          |
|                      | American.                                     |
+----------------------+-----------------------------------------------+
| **Denominator**      | Number of degrees awarded by accredited       |
|                      | pharmacy schools to all persons.              |
+----------------------+-----------------------------------------------+
| **Population         | Students in accredited pharmacy schools.      |
| Targeted**           |                                               |
+----------------------+-----------------------------------------------+
| **Questions Used To  | Not applicable.                               |
| Obtain the National  |                                               |
| Data**               |                                               |
+----------------------+-----------------------------------------------+
| **Expected           | Annual.                                       |
| Periodicity**        |                                               |
+----------------------+-----------------------------------------------+
| **Comments**         | See Comments provided with objective 1-8q for |
|                      | more information.                             |
+----------------------+-----------------------------------------------+

  

1-8t. Hispanic or Latino---pharmacy.

  -----------------------------------------------------------------------
  **National Data         Profile of Pharmacy Students, American
  Source**                Association of Colleges of Pharmacy.
  ----------------------- -----------------------------------------------
  **State Data Source**   Profile of Pharmacy Students, American
                          Association of Colleges of Pharmacy.

  **Healthy People 2000   Adapted from 21.8 (Clinical Preventive
  Objective**             Services).

  **Measure**             Percent.

  **Baseline**            2.8 (1996--97).

  **Numerator**           Number of degrees awarded by accredited
                          pharmacy schools to Hispanic or Latino persons.

  **Denominator**         Number of degrees awarded by accredited
                          pharmacy schools to all persons.

  **Population Targeted** Students in accredited pharmacy schools.

  **Questions Used To     Not applicable.
  Obtain the National     
  Data**                  

  **Expected              Annual.
  Periodicity**           

  **Comments**            See Comments provided with objective 1-8q for
                          more information.
  -----------------------------------------------------------------------

  

1-9. Reduce hospitalization rates for three ambulatory-care-sensitive
conditions---pediatric asthma, uncontrolled diabetes, and
immunization-preventable pneumonia and influenza.

1-9a. Pediatric asthma---persons under age 18 years.

  -----------------------------------------------------------------------
  **National Data         Healthcare Cost and Utilization Project (HCUP),
  Source**                AHRQ (formerly AHCPR).
  ----------------------- -----------------------------------------------
  **State Data Source**   See Comments.

  **Healthy People 2000   Adapted from 11.1b (Environmental Health).
  Objective**             

  **Measure**             Rate per 10,000 population.

  **Baseline**            23.0 (1996) (selected States---see Comments).

  **Numerator**           Number of hospitalizations among persons under
                          18 years with asthma (ICD-9-CM code 493) as the
                          first-listed (principal) diagnosis.

  **Denominator**         Number of persons under age 18 years.

  **Population Targeted** Resident persons (selected States---see
                          Comments).

  **Questions Used To     Not applicable.
  Obtain the National     
  Data**                  

  **Expected              Annual.
  Periodicity**           

  **Comments**            HCUP contains a hospital inpatient discharge
                          database that includes 100 percent of hospitals
                          and 100 percent of discharges from 19 States in
                          1996 and 22 States in 1997. A sample of
                          hospitals has been drawn from this that can be
                          used to derive estimates for the U.S.
                          population.

                          Data by race and ethnicity are not available,
                          although State-level data are available for 7
                          of the 22 States that participated in HCUP in
                          1997. AHRQ is developing a Minority National
                          Inpatient Sample as part of HCUP that will
                          provide national estimates of disparities in
                          avoidable hospitalization rates by race and
                          ethnicity.

                          This measure is a modification of Healthy
                          People 2000 objective 11.1b, which tracked
                          asthma hospitalizations among children under
                          age 14 years, using data from the National
                          Hospital Discharge Survey, CDC, NCHS. This
                          measure tracks persons aged 18 years and under,
                          using data from the Healthcare Cost and
                          Utilization Project (HCUP), AHRQ (formerly
                          AHCPR).

                          See Appendix A for focus area contact
                          information.
  -----------------------------------------------------------------------

-    

1-9b. Uncontrolled diabetes---persons aged 18 to 64 years.

  -----------------------------------------------------------------------
  **National Data         Healthcare Cost and Utilization Project (HCUP),
  Source**                AHRQ (formerly AHCPR).
  ----------------------- -----------------------------------------------
  **State Data Source**   See Comments.

  **Healthy People 2000   Not applicable.
  Objective**             

  **Measure**             Rate per 10,000 population.

  **Baseline**            7.2 (1996) (selected States---see Comments).

  **Numerator**           Number of hospitalizations among persons aged
                          18 to 64 years with uncontrolled diabetes
                          (ICD-9-CM codes 250.02-250.03, 250.10-250.13,
                          250.20-250.23, 250.30-250.33) as the
                          first-listed (principal) diagnosis.

  **Denominator**         Number of persons aged 18 to 64 years.

  **Population Targeted** Resident persons (selected States---see
                          Comments).

  **Questions Used To     Not applicable.
  Obtain the National     
  Data**                  

  **Expected              Annual.
  Periodicity**           

  **Comments**            See Comments provided with objective 1-9a for
                          more information.
  -----------------------------------------------------------------------

  

1-9c. Immunization-preventable pneumonia or influenza---persons aged 65
years and older.

  -----------------------------------------------------------------------
  **National Data         Healthcare Cost and Utilization Project (HCUP),
  Source**                AHRQ (formerly AHCPR).
  ----------------------- -----------------------------------------------
  **State Data Source**   See Comments.

  **Healthy People 2000   Not applicable.
  Objective**             

  **Measure**             Rate per 10,000 population.

  **Baseline**            10.6 (1996) (selected States---see Comments).

  **Numerator**           Number of hospitalizations among persons aged
                          65 years and older with preventable pneumonia
                          or influenza (ICD-9-CM codes 481, 487) as the
                          first-listed (principal) diagnosis.

  **Denominator**         Number of persons aged 65 years and older.

  **Population Targeted** Resident persons (selected States---see
                          Comments).

  **Questions Used To     Not applicable.
  Obtain the National     
  Data**                  

  **Expected              Annual.
  Periodicity**           

  **Comments**            See Comments provided with objective 1-9a for
                          more information.
  -----------------------------------------------------------------------

  

### Emergency Services

  -----------------------------------------------------------------------
  1-10. (Developmental)   
  Reduce the proportion   
  of persons who delay or 
  have difficulty in      
  getting emergency       
  medical care.           
  ----------------------- -----------------------------------------------
  **Comments**            An operational definition could not be
                          specified at the time of publication.

                          The proposed national data source is the
                          National Health Interview Survey (NHIS), CDC,
                          NCHS.

                          The proposed numerator is the number of persons
                          who report that they delayed or had difficulty
                          getting emergency medical care because of any
                          one of several possible barriers, including
                          unsure if emergency medical care needed; needed
                          to contact health care provider or health plan;
                          could not take time off from work; needed child
                          care; did not have transportation; ambulance
                          did not arrive quickly; no health insurance;
                          health plan requires co-payment; health plan
                          requires pre-authorization; concerned that
                          health plan would not pay for emergency visit;
                          referred out of the emergency room without
                          treatment; long wait in the emergency room/ or
                          emergency medical facility; or an other
                          specified reason.

                          The proposed denominator is the number of
                          adults in the survey population aged 18 years
                          and older weighted to the U.S. civilian,
                          noninstitutionalized population.

                          The proposed questions to be used to obtain the
                          data are scheduled to be included in the 2001
                          NHIS.

                          See Part C for a description of NHIS and
                          Appendix A for focus area contact information.
  -----------------------------------------------------------------------

  

  -----------------------------------------------------------------------
  1-11. (Developmental)   
  Increase the proportion 
  of persons who have     
  access to rapidly       
  responding prehospital  
  emergency medical       
  services.               
  ----------------------- -----------------------------------------------
  **Comments**            An operational definition could not be
                          specified at the time of publication.

                          The proposed national data source is the Annual
                          Survey of EMS Operations, International
                          Association of Firefighters.

                          See Appendix A for focus area contact
                          information.
  -----------------------------------------------------------------------

  

+----------------------+-----------------------------------------------+
| 1-12. Establish a    |                                               |
| single toll-free     |                                               |
| telephone number for |                                               |
| access to poison     |                                               |
| control centers on a |                                               |
| 24-hour basis        |                                               |
| throughout the       |                                               |
| United States.       |                                               |
+======================+===============================================+
| **National Data      | American Association of Poison Control        |
| Source**             | Centers Survey, U.S. Poison Centers.          |
+----------------------+-----------------------------------------------+
| **State Data         | Not identified.                               |
| Source**             |                                               |
+----------------------+-----------------------------------------------+
| **Healthy People     | Not applicable.                               |
| 2000 Objective**     |                                               |
+----------------------+-----------------------------------------------+
| **Measure**          | Percent.                                      |
+----------------------+-----------------------------------------------+
| **Baseline**         | 15 (1999).                                    |
+----------------------+-----------------------------------------------+
| **Numerator**        | Number of Poison Control Centers (PCCs) that  |
|                      | report the same single toll-free telephone    |
|                      | number for immediate information and          |
|                      | treatment advice about poisonings and toxic   |
|                      | exposures.                                    |
+----------------------+-----------------------------------------------+
| **Denominator**      | Number of PCCs nationwide.                    |
+----------------------+-----------------------------------------------+
| **Questions Used To  | From the 1999 American Association of Poison  |
| Obtain the National  | Control Centers Survey:                       |
| Data**               |                                               |
+----------------------+-----------------------------------------------+
|                      | -   What emergency telephone numbers do you   |
|                      |     advertise?                                |
+----------------------+-----------------------------------------------+
| **Expected           | Annual.                                       |
| Periodicity**        |                                               |
+----------------------+-----------------------------------------------+
| **Comments**         | The numerator is based on the number of PCCs  |
|                      | that report the same toll-free telephone      |
|                      | number that is advertised to provide          |
|                      | immediate information and treatment advice    |
|                      | about poisonings and toxic exposures.         |
+----------------------+-----------------------------------------------+
|                      | For the denominator, the total number of PCCs |
|                      | nationwide for 1999 is 74.                    |
+----------------------+-----------------------------------------------+
|                      | See Appendix A for focus area contact         |
|                      | information.                                  |
+----------------------+-----------------------------------------------+

  

+----------------------+-----------------------------------------------+
| 1-13. Increase the   |                                               |
| number of Tribes,    |                                               |
| States, and the      |                                               |
| District of Columbia |                                               |
| with trauma care     |                                               |
| systems that         |                                               |
| maximize survival    |                                               |
| and functional       |                                               |
| outcomes of trauma   |                                               |
| patients and help    |                                               |
| prevent injuries     |                                               |
| from occurring.      |                                               |
+======================+===============================================+
| **National Data      | State EMS Directors Survey, National          |
| Source**             | Association of State EMS Directors.           |
+----------------------+-----------------------------------------------+
| **State Data         | Not identified.                               |
| Source**             |                                               |
+----------------------+-----------------------------------------------+
| **Healthy People     | Not applicable.                               |
| 2000 Objective**     |                                               |
+----------------------+-----------------------------------------------+
| **Measure**          | Number.                                       |
+----------------------+-----------------------------------------------+
| **Baseline**         | 5 (1998).                                     |
+----------------------+-----------------------------------------------+
| **Numerator**        | Number of States and the District of Columbia |
|                      | that satisfied all eight trauma care system   |
|                      | criteria.                                     |
+----------------------+-----------------------------------------------+
| **Denominator**      | Not applicable.                               |
+----------------------+-----------------------------------------------+
| **Questions Used To  | From the 1998 National Association of State   |
| Obtain the National  | EMS Directors Survey of EMS directors:        |
| Data**               |                                               |
+----------------------+-----------------------------------------------+
|                      | -   Does someone in your State have legal     |
|                      |     authority to "designate, certify,         |
|                      |     identify, or categorize" trauma centers?  |
+----------------------+-----------------------------------------------+
|                      | -   Is there a formal process to designate or |
|                      |     otherwise identify trauma centers?        |
+----------------------+-----------------------------------------------+
|                      | -   What standards are used for               |
|                      |     designating/identifying trauma centers?   |
+----------------------+-----------------------------------------------+
|                      | -   As part of the designation process, are   |
|                      |     the trauma centers surveyed through       |
|                      |     on-site evaluations for the purpose of    |
|                      |     verifying compliance with standards?      |
+----------------------+-----------------------------------------------+
|                      | -   Is there authority to limit the number of |
|                      |     trauma centers based on need?             |
+----------------------+-----------------------------------------------+
|                      | -   Are there written prehospital triage      |
|                      |     protocols/criteria to transport seriously |
|                      |     injured patients directly to a trauma     |
|                      |     center, bypassing other facilities that   |
|                      |     are not trauma centers?                   |
+----------------------+-----------------------------------------------+
|                      | -   Is there a process for monitoring trauma  |
|                      |     center performance?                       |
+----------------------+-----------------------------------------------+
|                      | -   Does your State's system of trauma care   |
|                      |     consist of a single statewide trauma      |
|                      |     system?                                   |
+----------------------+-----------------------------------------------+
| **Expected           | Annual.                                       |
| Periodicity**        |                                               |
+----------------------+-----------------------------------------------+
| **Comments**         | The eight criteria for State trauma care      |
|                      | systems used in the National Association of   |
|                      | State EMS Directors Survey of EMS directors   |
|                      | in all 50 States and the District of Columbia |
|                      | are legal authority exists to designate,      |
|                      | certify, identify, or categorize trauma       |
|                      | centers; a formal process exists to designate |
|                      | or otherwise identify trauma centers; the     |
|                      | American College of Surgeons (ACS) standards  |
|                      | are used to designate or identify trauma      |
|                      | centers; trauma center compliance with the    |
|                      | ACS standards is verified through on-site     |
|                      | evaluations; legal authority exists to limit  |
|                      | the number of trauma centers based on the     |
|                      | need for trauma services; existence of        |
|                      | prehospital triage protocols for trauma       |
|                      | patients, allowing providers to bypass        |
|                      | nontrauma center hospitals and transport      |
|                      | seriously injured patients directly to a      |
|                      | trauma center; a process for monitoring       |
|                      | trauma center performance exists; and trauma  |
|                      | system coverage extends to the entire         |
|                      | geographic area of the State.                 |
+----------------------+-----------------------------------------------+
|                      | Data for Tribes are developmental. The        |
|                      | proposed data source is the Indian Health     |
|                      | Service.                                      |
+----------------------+-----------------------------------------------+
|                      | See Appendix A for focus area contact         |
|                      | information.                                  |
+----------------------+-----------------------------------------------+

  

1-14. Increase the number of States and the District of Columbia that
have implemented guidelines for prehospital and\
hospital pediatric care.

1-14a. Increase the number of States and the District of Columbia that
have implemented statewide pediatric protocols for online\
medical direction.

+----------------------+-----------------------------------------------+
| **National Data      | Emergency Medical Services for Children       |
| Source**             | Annual Grantees Survey, HRSA.                 |
+======================+===============================================+
| **State Data         | Emergency Medical Services for Children       |
| Source**             | Annual Grantees Survey, HRSA.                 |
+----------------------+-----------------------------------------------+
| **Healthy People     | Not applicable.                               |
| 2000 Objective**     |                                               |
+----------------------+-----------------------------------------------+
| **Measure**          | Number of States and the District of          |
|                      | Columbia.                                     |
+----------------------+-----------------------------------------------+
| **Baseline**         | 18 (1997).                                    |
+----------------------+-----------------------------------------------+
| **Numerator**        | Number of States that have pediatric          |
|                      | protocols for both online medical direction   |
|                      | of emergency medical technicians (EMTs) and   |
|                      | paramedics at the scene of an emergency and   |
|                      | overall medical direction in the development  |
|                      | of written pediatric protocols, medical       |
|                      | policies, and guidelines.                     |
+----------------------+-----------------------------------------------+
| **Denominator**      | Not applicable.                               |
+----------------------+-----------------------------------------------+
| **Questions Used To  | From the 1997 Emergency Medical Services for  |
| Obtain the National  | Children Annual Grantees Survey:              |
| Data**               |                                               |
+----------------------+-----------------------------------------------+
|                      | -   Does your State have a designated         |
|                      |     pediatric health professional involved in |
|                      |     the development of guidelines, protocols, |
|                      |     procedures, and policies, as well as      |
|                      |     planning for training in and evaluation   |
|                      |     of their use?                             |
+----------------------+-----------------------------------------------+
|                      | -   Does your State provide for online        |
|                      |     medical direction by a professional       |
|                      |     trained in the unique emergency medical   |
|                      |     services needs of children?               |
+----------------------+-----------------------------------------------+
| **Expected           | Annual.                                       |
| Periodicity**        |                                               |
+----------------------+-----------------------------------------------+
| **Comments**         | This measure tracks the level of overall      |
|                      | medical direction provided to States by       |
|                      | physicians trained in the special needs of    |
|                      | children when developing guidelines,          |
|                      | protocols, procedures, and policies, as well  |
|                      | as planning the training for and              |
|                      | participating in the evaluation of their use. |
+----------------------+-----------------------------------------------+
|                      | This measure also tracks the number of States |
|                      | that have EMS medical directors available to  |
|                      | communicate directly with EMTs at the scene   |
|                      | and during transport. Both overall medical    |
|                      | direction and online direction must be        |
|                      | available to respond \"yes\" to this measure. |
+----------------------+-----------------------------------------------+
|                      | Online medical direction involves direct      |
|                      | communication (for example, voice) between    |
|                      | EMS medical directors and EMTs and paramedics |
|                      | to authorize and guide the care of patients   |
|                      | during transport.                             |
+----------------------+-----------------------------------------------+
|                      | The Emergency Medical Services for Children   |
|                      | Annual Grantees Survey surveys a grantee from |
|                      | each of the 50 States, the District of        |
|                      | Columbia, and 6 U.S. Territories.             |
+----------------------+-----------------------------------------------+
|                      | See Appendix A for focus area contact         |
|                      | information.                                  |
+----------------------+-----------------------------------------------+

  

1-14b. Increase the number of States and the District of Columbia that
have adopted and disseminated pediatric guidelines that\
categorize acute care facilities with the equipment, drugs, trained
personnel, and other resources necessary to provide varying levels of
pediatric emergency and critical care.

+----------------------+-----------------------------------------------+
| **National Data      | Emergency Medical Services for Children       |
| Source**             | Annual Grantees Survey, HRSA.                 |
+======================+===============================================+
| **State Data         | Emergency Medical Services for Children       |
| Source**             | Annual Grantees Survey, HRSA.                 |
+----------------------+-----------------------------------------------+
| **Healthy People     | Not applicable.                               |
| 2000 Objective**     |                                               |
+----------------------+-----------------------------------------------+
| **Measure**          | Number of States and the District of          |
|                      | Columbia.                                     |
+----------------------+-----------------------------------------------+
| **Baseline**         | 11 (1997).                                    |
+----------------------+-----------------------------------------------+
| **Numerator**        | Number of States and the District of Columbia |
|                      | that have adopted and disseminated pediatric  |
|                      | guidelines that categorize acute care         |
|                      | facilities with the equipment, drugs, trained |
|                      | personnel, and resources necessary to provide |
|                      | varying levels of pediatric emergency and     |
|                      | critical care.                                |
+----------------------+-----------------------------------------------+
| **Denominator**      | Not applicable.                               |
+----------------------+-----------------------------------------------+
| **Questions Used To  | From the 1997 Emergency Medical Services for  |
| Obtain the National  | Children Annual Grantees Survey:              |
| Data**               |                                               |
+----------------------+-----------------------------------------------+
|                      | -   Does your State have pediatric guidelines |
|                      |     that categorize acute care facilities     |
|                      |     with the equipment, drugs, trained        |
|                      |     personnel, and resources necessary to     |
|                      |     provide varying levels of pediatric       |
|                      |     emergency and critical care?              |
+----------------------+-----------------------------------------------+
| **Expected           | Annual.                                       |
| Periodicity**        |                                               |
+----------------------+-----------------------------------------------+
| **Comments**         | This measure tracks the number of States with |
|                      | either a mandatory or voluntary system with   |
|                      | written guidelines and procedures for         |
|                      | identifying acute care facilities with the    |
|                      | appropriate equipment, drugs, trained         |
|                      | personnel, and resources necessary to provide |
|                      | varying levels of pediatric emergency care.   |
+----------------------+-----------------------------------------------+
|                      | The Emergency Medical Services for Children   |
|                      | Annual Grantees Survey surveys a grantee from |
|                      | each of the 50 States, the District of        |
|                      | Columbia, and 6 U.S. Territories.             |
+----------------------+-----------------------------------------------+
|                      | See Appendix A for focus area contact         |
|                      | information.                                  |
+----------------------+-----------------------------------------------+

### Long-Term Care and Rehabilitative Services {#long-term-care-and-rehabilitative-services-1 .Heading3Inside}

  -----------------------------------------------------------------------
  1-15. (Developmental)   
  Increase the proportion 
  of persons with         
  long-term care needs    
  who have access to the  
  continuum of long-term  
  care services.          
  ----------------------- -----------------------------------------------
  **Comments**            An operational definition could not be supplied
                          at the time of publication.

                          Proposed national data sources are the National
                          Long-Term Care Survey, Medicare Current
                          Beneficiary Survey, HCFA; National Health
                          Interview Survey (NHIS), CDC, NCHS; or the
                          Medical Expenditure Panel Survey (MEPS), AHRQ
                          (formerly AHCPR).

                          A continuum of care includes nursing home care,
                          home health care, adult day care, assisted
                          living, and hospice care.

                          Long-term care needs are defined as needing the
                          help of another person with personal care such
                          as eating, bathing, dressing, and getting
                          around in the home or needing the help of other
                          persons with routine needs such as everyday
                          chores, doing necessary business, shopping, or
                          getting around for other purposes are also
                          included. Persons without access to the
                          continuum of long-term care services are those
                          with long-term care needs who report needing
                          long-term care services but not receiving them
                          in the past 12 months.

                          See Appendix A for focus area contact
                          information.
  -----------------------------------------------------------------------

  

+----------------------+-----------------------------------------------+
| 1-16. Reduce the     |                                               |
| proportion of        |                                               |
| nursing home         |                                               |
| residents with a     |                                               |
| current diagnosis of |                                               |
| pressure ulcers.     |                                               |
+======================+===============================================+
| **National Data      | National Nursing Home Survey (NNHS), CDC,     |
| Source**             | NCHS.                                         |
+----------------------+-----------------------------------------------+
| **State Data         | Not identified.                               |
| Source**             |                                               |
+----------------------+-----------------------------------------------+
| **Healthy People     | Not applicable.                               |
| 2000 Objective**     |                                               |
+----------------------+-----------------------------------------------+
| **Measure**          | Rate per 1,000 population.                    |
+----------------------+-----------------------------------------------+
| **Baseline**         | 16 (1997).                                    |
+----------------------+-----------------------------------------------+
| **Numerator**        | Number of nursing home residents reported to  |
|                      | have a current diagnosis of a stage II or     |
|                      | greater pressure ulcer (ICD-9-CM codes        |
|                      | 707.0-707.1 or 454.0).                        |
+----------------------+-----------------------------------------------+
| **Denominator**      | Number of nursing home residents.             |
+----------------------+-----------------------------------------------+
| **Population         | U.S. resident population.                     |
| Targeted**           |                                               |
+----------------------+-----------------------------------------------+
| **Questions Used To  | From the 1997 National Nursing Home Survey:   |
| Obtain the National  |                                               |
| Data**               |                                               |
+----------------------+-----------------------------------------------+
|                      | -   According to ([nursing home resident's    |
|                      |     name]{.underline}) medical record, what   |
|                      |     were ([nursing home resident's            |
|                      |     name]{.underline}) the primary and other  |
|                      |     diagnoses at the time of admission on     |
|                      |     ([patient's date of                       |
|                      |     admission]{.underline})?                  |
|                      |                                               |
|                      |     Primary diagnosis: 1                      |
|                      |     \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\       |
|                      |     Others: 2                                 |
|                      |     \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\       |
|                      |     3 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\     |
|                      |     4 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\     |
|                      |     5 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\     |
|                      |     6 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_      |
+----------------------+-----------------------------------------------+
|                      | -   According to ([nursing home resident's    |
|                      |     name]{.underline}) medical record, what   |
|                      |     are ([nursing home resident's             |
|                      |     name]{.underline}) current primary and    |
|                      |     other diagnoses?                          |
|                      |                                               |
|                      |     Same as above                            |
|                      |                                               |
|                      |     (If not the same:)                        |
|                      |                                               |
|                      |     Primary diagnosis: 1                      |
|                      |     \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\       |
|                      |     Others: 2                                 |
|                      |     \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\       |
|                      |     3 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\     |
|                      |     4 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\     |
|                      |     5 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\     |
|                      |     6 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_      |
+----------------------+-----------------------------------------------+
| **Expected           | Biennial.                                     |
| Periodicity**        |                                               |
+----------------------+-----------------------------------------------+
| **Comments**         | This measure includes any mention of a stage  |
|                      | II or greater pressure ulcer, as either the   |
|                      | "Primary" or "Other" diagnosis.               |
+----------------------+-----------------------------------------------+
|                      | Tracking the rate of new cases is the most    |
|                      | appropriate way to measure problems with      |
|                      | pressure ulcers, however, such data are not   |
|                      | currently available at the national level.    |
|                      | The current NNHS measure tracks the total     |
|                      | number of cases at the time of interview.     |
+----------------------+-----------------------------------------------+
|                      | See Appendix A for focus area contact         |
|                      | information.                                  |
+----------------------+-----------------------------------------------+

  

## References

1\. National Center for Health Statistics (NCHS). *Health, United
States, 2000 with Adolescent Health Chartbook.* Hyattsville, MD: NCHS,
2000, Table 128.

2\. Association of American Medical Colleges (AAMC). *AAMC Data Book:
Statistical Information Related to Medical Schools and Teaching
Hospitals.* Washington, DC: AAMC, 1999.

3\. Association of Schools of Public Health (ASPH). *1998 Annual Data
Report: Applications, New Enrollments, and Students.* Fall 1998,
Graduates and Expenditures, 1997--98 With Trend Analysis 1987--88
through Fall 1998. Washington, DC: ASPH, 1999.

4\. American Dental Association (ADA). *1997/98 Survey of Predoctoral
Dental Educational Institutions: Academic Programs, Enrollment, and
Graduates.* Vol. 1. Chicago, IL: ADA, 1999.

5\. American Association of Colleges of Pharmacy (AACP). *Institutional
Research Report Series: Profile of Pharmacy Health Students.*
Alexandria, VA: AACP, 1999.

6\. National League for Nursing (NLN). *Nursing DataSource 1997.* Vol.
1---Trends in Contemporary RN Nursing Education. New York, NY: NLN,
1997.