Department  of  Health and Human  Services 
OFFICE  OF 
INSPECTOR  GENERAL 
HEALTHY  DIFFERENCE  --
LESSONS  LEARNED  ABOUT 
INFORMATION  DISSEMINATION 
AUGUST  1993  OFFICE  OF  INSPECTOR  GENERAL 
The  mission of the  Office of Inspector  General  (OIG),  as mandated  by Public  Law 95-452, as 
amended,  is to protect  the  integrity  of the Department  of Health  and Human  Services (HHS) 
programs  as well as the  health  and welfare  of beneficiaries  served  by those  programs.  This 
statutory  mission is carried  out  through  a nationwide  network  of audits,  investigations,  and 
inspections  conducted  by three  OIG  operating  components:  the  Office of Audit  Services,  the 
Office of Investigations,  and the  Office of Evaluation  and Inspections.  The  OIG  also informs 
the  Secretary  of HHS  of program  and management  problems  and recommends  courses  to 
correct  them. 
OFFICE  OF AUDIT  SERVICES 
The  OIGS Office of Audit  Services  (OAS)  provides  all auditing  services for HHS,  either  by 
conducting  audits with its own audit  resources  or by overseeing  audit work done  by others. 
Audits  examine  the  performance  of HHS  programs  and/or  its grantees  and contractors  in 
carrying out  their  respective  responsibilities  and are intended  to provide  independent 
assessments  of HHS  programs  and operations  in order  to reduce  waste,  abuse,  and 
mismanagement  and to promote  economy  and efficiency throughout  the  Department. 
OFFICE  OF INVESTIGATIONS 
The  OIGS Office of Investigations  (01)  conducts  criminal, civil, and administrative 
investigations  of allegations  of wrongdoing  in HHS  programs  or to HHS  beneficiaries  and of 
unjust  enrichment  by providers.  The  investigative  efforts  of 01  lead to criminal  convictions, 
administrative  sanctions,  or civil money  penalties.  The  01  also oversees  State  Medicaid  fraud 
control  units which investigate  and prosecute  fraud  and patient  abuse  in the  Medicaid  program. 
OFFICE  OF EVALUATION  AND  INSPECTIONS 
The  OIGS Office of Evaluation  and Inspections  (OEI)  conducts  short-term  management  and

program  evaluations  (called  inspections)  that  focus on issues of concern  to the  Department,

the  Congress,  and the  public.  The  findings and recommendations  contained  in these  inspection

reports  generate  rapid,  accurate,  and up-to-date  information  on the  efficiency, vulnerability,

and effectiveness  of departmental  programs.

This report  was prepared  in the Public  Health  and Human  Services Branch  under  the  direction

of Emilie  Baebel.  Project  staffi

Mary Beth  Clarke,  Project Leader

Brian  Rawdon,  Analyst

Mark  Krushat,  SC.D., Mothemotical  Statistician

Linda  Moscoe,  Program Anolyst
 Department  of  Health  and Human  Services 
OFFICE  OF 
INSPECTOR  GENERAL 
HEALTHY  DIFFERENCE  --
LESSONS  LEARNED  ABOUT 
INFORMATION  DISSEMINATION 
AUGUST  1993  OEI-12-91-01430
 PURPOSE

The  purpose  of this  report  is to  describe  deficiencies  in the  dissemination  strategy  of 
the  Healthy  Difference  program  and  in some  of the  Departments  data  bases  of 
information  on  grantees,  field  offices,  and  other  essential  contacts. 
BACKGROUND

The  Healthy  Difference  program  was  part  of a Secretarial  initiative  to  improve  the

health  and  well-being  of individuals  through  improved  preventive  care  and  promotion

of personal  responsibility  for  ones  health.  The  Healthy  Difference  component

consisted  of a series  of four  packages  of health  promotion  materials  mailed  to  selected

Department  of Health  and  Human  Services  (HHS)  grantees,  field  offices,  and  other

selected  contacts  between  April  1991  and  March  1992.  The  program  was  sent  out  to

approximately  25,000  participants  with  a total  project  cost  of $113,000.  The

participants  consisted  of HHS  grantees,  field  offices,  and  other  appropriate  contacts  in

the  fields  of public  health,  health  care  facilities,  income  maintenance,  and  human

development  services.

The  evaluation  of the  initiative  consisted  of a survey  mailed  to  a sample  of Healthy

Difference  participants  to  solicit  their  perceptions  of the  program.  In  order  to  draw  a

representative  sample  for  the  survey,  a master  data  base  of all  Healthy  Difference

participants  had  to  be  created.  The  Office  of Inspector  General  (OIG)  requested  that

all  of the  HHS  agencies  provide  this  information  in a database  format.  Surveys  were

mailed  to  a sample  of 2514  participants  in December  1991.  We  received  720  usable

surveys  yielding  a total  response  rate  of 29 percent.  The  information  presented  in this

report  was  collected  from  the  surveys  received  and  experiences  in  conducting  the

evaluation.  There  was  no  attempt  to  validate  the  self-reported  information  from  the

survey  or  to  measure  bias.

The  evaluation  revealed  weaknesses  both  in the  dissemination  strategy  for  the  Healthy

Difference  program  and  certain  information  systems  maintained  independently  by

agencies  within  the  Department.  The  Departments  Grants  Management  Information

Systems  were  not  used  in the  dissemination  of  the  Healthy  Difference  materials  or  this

evaluation.  Therefore,  any  statements  made  concerning  accuracy  or  reliability  of data

base  systems  do  not  refer  to  the  Grants  Management  Information  Systems.

FINDINGS

1. More lhan half of the respondents were not aware that they had received the Healthy 
Difference program materials. 
By using  selected  grantees,  field  offices,  and  other  contacts,  the  Healthy  Difference 
program  was  intended  to  reach  a large  audience.  However,  of the  surveys  returned, 
58 percent  indicated  that  they  had  not  received  the  Healthy  Difference  materials,  and 
1
 therefore  could  not  use  or  publicize  the  health  promotion  materials  to  their  client 
population  or  other  interested  groups.  This  figure  cannot  be  projected  to  the  universe 
of all Healthy  Difference  participants,  because  of the  low  response  rate  of our  survey. 
However,  the  low  response  rate  might  itself  be  a further  indication  of the  unreliability 
of the  addressee  information  from  the  data  bases. 
2. 2%e Healthy Difference program could not be further evaluated. 
When  requested  to  provide  the  OIG  with  mailing  information  on  the  participants  of 
the  Healthy  Difference  program  in  a data  base  format,  several  agencies  where  unable 
to  fully  comply.  Even  in  cases  where  agencies  were  able  to  provide  this  information, 
they  often  could  not  guarantee  that  the  information  was  identical  to  the  hard  copy 
information  (mailing  labels)  provided  to  Public  Health  Service  (PHS)  to  mail  out  the 
original  program  materials.  Without  a complete  and  accurate  master  data  base  from 
which  to  draw  a sample,  the  evaluation  could  not  yield  meaningful  results 
generalizable  to  the  universe  of all Healthy  Difference  participants.  Furthermore,  as 
indicated  in the  background  section,  the  response  rate  was  only  29 percent,  which  was 
lower  than  the  50 percent  intended  in  the  evaluation  design.  Finally,  as  indicated  in 
the  first  finding,  most  respondents  were  not  aware  of receiving  the  materials,  a further 
indication  of  unreliability  in  the  information  from  the  data  bases. 
3. i%e data bases provided by the agencies cannot be reliably Wed to disseminate 
Department-wide information, such as was attempted with the Healthy Di#erence 
program. 
The  decision  to  disseminate  the  Healthy  Difference  program  to  selected  grantees,  field 
offices,  and  other  essential  contacts  was  based  on  a belief  that  all  of these  groups, 
including  those  of social  service  nature,  would  benefit  from  receiving  health  promotion 
messages.  For  this  to  work  successfully,  agencies  have  to  be  able  to  provide  accurate 
information  regarding  the  identity  of intended  respondents  and  be  able  to  duplicate  it. 
As  indicated  above,  this  was  not  possible.  We  are  aware  that  in participating  in  the 
Healthy  Difference  program,  agencies  did  not  access  the  Departments  grants 
management  systems  managed  by the  separate  operating  divisions.  However,  the  data 
base  systems  accessed  for  the  Healthy  Difference  program  clearly  are  being  used  by 
the  agencies  to  transmit  program  information  to  both  grantees  and  a wider  audience 
of other  entities.  Until  the  accuracy  of these  systems  can  be  verified,  they  cannot  be 
used  to  reliably  disseminate  information  on  such  a broad  scale.  The  deficiencies  noted 
in the  information  obtained  from  the  agency-operated  data  base  systems  are  significant 
and  may  impair  the  ability  of  agencies  to  disseminate  important  information  to 
grantees  and  other  essential  contacts  as part  of agencies  missions.  Consequently,  the 
public  may  be  deprived  of needed  information  and  services. 
2
 The Assktant  Secreta~ for Public Aflaim with the Assistant Secretaryfor Management 
and Budget should develop guidelines to ensure the accuracy in agency-operated data base 
~stems  used to dikeminate  information. 
Up-to-date,  complete  information  in an  accessible  data  base  format  on  all  of the 
Departments  grantees,  field  offices,  and  other  essential  contacts  is critical  to 
adequately  fulfilling  the  Departments  mission.  Continued  use  of agency-operated 
data  base  systems  without  assurances  of accuracy  will  result  in  unsuccessful 
dissemination  efforts. 
COMMENTS

In  comments  to  the  draft  report,  the  Office  of the  Assistant  Secretary  for  Public 
Affairs  concurred  with  our  recommendation  and  welcomes  the  support  of ASMB  in 
their  efforts  to  develop  guidelines  to  improve  the  accuracy  of public  affairs  data  bases. 
In  comments  to  the  draft  report,  the  Assistant  Secretary  for  Management  and  Budget 
concurred  with  our  recommendation  and  indicated  willingness  to  support  the  Assistant 
Secretary  for  Public  Affairs  in  developing  guidelines  to  ensure  the  accuracy  of agency 
operated  data  bases  used  for  dissemination  purposes. 
However,  ASMB  disagreed  with  our  finding  concerning  the  relationship  between  the 
inaccuracy  of these  data  bases  and  resulting  difficulties  in evaluating  the  Healthy 
Difference  initiative,  and  whether  in fact,  the  noted  difficulties  truly  reflected  accuracy 
problems  with  these  data  bases.  We  continue  to  believe  that  the  problems  uncovered 
during  the  evacuation  are  indicative  of underlying  systematic  problems.  The  fact  that 
over  50 percent  of our  survey  respondents  indicated  they  had  never  received  the 
Healthy  Difference  materials  is evidence  that  these  data  bases  are  not  completely 
accurate  and  are  therefore  unreliable  for  department-wide  dissemination  efforts. 
In  their  comments  ASMB  notes  that  the  primary  difficulty  in  evaluating  the  Healthy 
Difference  initiative  was  the  failure  to  maintain  a copy  of the  ad  hoc  mailing  list  by 
the  program  staff.  While  this  technically  is true,  it was  the  individual  agencies 
participating  that  failed  to  maintain  copies  of the  mailing  lists.  The  PHS  staff 
responsible  for  coordinating  the  mailing  of the  materials  received  only  mailing  labels 
from  the  various  agencies.  It is unreasonable  to  expect  that  PHS  would  make  and 
retain  copies  of  all  25,000  mailing  labels.  One  of the  assumed  benefits  of automating 
this  type  information  and  maintaining  a data  base  system  is the  efficiency  of  effort 
needed  to  access  the  information  and  the  reduced  needed  for  hard  copy  systems. 
The  comments  from  OASPA  and  ASMB  are  reprinted  in full  at  the  conclusion  of this 
report. 
3  Officeofthesecremw

Washin@on, D.C. 20201 
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199J3U
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TO:	 Bryan B. Mitchell

Principal Deputy Inspector General

FR:	 Campbell Gardet  Oyg.  ~~ 
Director, News Z&J&?@ 
Office of the Assistant Secretary for Pu ~+@#@ 
# 
-

RE:	 OIG Draft Report:  Healthy Difference -- Lessons Learned

About Information Disseminationst OEL/z-Y-~l~~L

Thank you for giving OASPA the opportunity to comment on your

draft report regarding information disseminationunder the

Healthy-Differencel$campaign.  -

Because of the change of Administrations and the absence of a

Director of the Communications Services Division-of OASPA, this

reply is extremely tardy, for which I take blame and apologize.

It had been my hope that a new director of the CSD Division would

be appointed in time to provide a more definitive response.

As regards the Healthy Differencectcampaign in particular, there

-- is little record in OASPA.  It is my understanding that this

campaign was a joint project with the Office for Disease

Prevention and Health Promotion in OASH and would not be counted

among the priority projects of OASPA.  Further, I am told by the

Communications Office of the Office of the Assistant Secretary

for Health that it was  ODPHP mailing lists which were used for

this campaign.  For a more complete understanding of the

campaign, the Office of Disease Prevention and Health Promotion

should be consulted.  Indeed, despite the lateness of the hour,

OASH should have the formal opportunity to comment on the report.

I suspect they would take issue with some of the findings

specifically related to the Healthy Difference campaign. 

The more important general question is the need for accurate and

well-targeted data bases.  In particular, the report recommends  ~

that the Assistant Secretary for Public Affairs work Witi the  _

Assistant Secretary for Management and Budget to develop

guidelines to ensure the accuracy of public affairs data bases

throughout the Department.  OASPA agrees entirely with the

finding of the report-that accuracy of data bases is essential to _

the effective dissemination of information.  For that reason,

efforts are currently underway to update data bases maintained by

OASPA.
 ) 
. 
- 
* 
Page 2

In addition, OASPA agrees that we  potential for Department-wide

guidelines should be examined.  OASPA will welcome the support of

ASMB in such an examination.

It may also be worth noting that OASPA and ASMB are currently  -
developing a reorganization of OASPA which  greater emphasis 
puts 
on outreach efforts, and that a prime task of a new outreach

division will be the development and maintenance of effective

mailing lists.

cc:	 Avis LaVelle 
Melissa Skolfield 
Teresa Venegas 
Gail Becker

Elizabeth James, ASMB

Bill Grigg, OASH



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:  DEPARTMENT  OF HEALTH&  HUMAN  SERVICES 
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MEMORANDUM TO: Bryan B. Mitchell

Principal Deputy Inspector Genera

FROM  : Elizabeth M. James

Acting Assistant S

Management and Budge

SUBJECT  : OIG Draft Report: Healthy Difference -

Learned about Information Dissemination, 0EI-12-

91-01430

Thank you for the opportunity to comment on the subject draft

report.  We concur with its recommendation and will support the

Assistant Secretary for Public Affairs in developing additional

guidelines to further ensure the accuracy of agency operated

mailing listw databases.

However, we cannot agree with the finding that use of the present

system will result in unsuccessful dissemination efforts.

Rather, our reading of the report found no information presented

to indicate problems with the information systems maintained

independently by agencies within the Department.

The report did find that this specific initiative failed to

retain a copy of its ad hoc mailing list, and it was this failure

that led directly to the ensuing inability to properly evaluate

the effectiveness of the dissemination initiative.

One other point on the report that needs to be addressed deals

with the process used in its preparation.  The draft report

states that a mailing of surveys to a sample of 2514

participants  (occurred) in December 1991$8. Our check with the OS

Reports Clearance Officer found that the survey was an

information collection under the Paperwork Reduction Act  and that 
the required approval of the Office of Management and Budget was 
not obtained.

If we may be of any further assistance in this matter or if your

staff have any questions on our comments, they should be diretited

to A Prentice Barnes, Sr. on (202) 690-5521.