--

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 OIG’S 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 OIG’S 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 OIG’S 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

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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 Department’s 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 one’s 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 Department’s 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 Department’s 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 

Department’s grantees, field offices, and other essential contacts is critical to 

adequately fulfilling the Department’s 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 
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Officeofthesecremw


Washin@on, D.C. 20201 

~~!j~R,’.’-

1993
JUL27 FM 3’10


.


TO:	 Bryan B. Mitchell


Principal Deputy Inspector General


FR:	 Campbell Gardet 

Director, News Z&J&?@ Oyg. ~~ 

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 puts greater emphasis 

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


—


_.— 

. 

> , 

. 
**”’ ‘“ ofthes=lmw


: DEPARTMENT OF HEALTH& HUMAN SERVICES Office


5


:~


%
4c 

%%<e,w
 WashiI@m, D.C. 20201

ApR-fi= 

- % w ~ 

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.