Health
Governor's Executive Budget Program Measures
Health Research
Calculated Lag (%) for Birth and Death Records
The calculated lag time is
measured for each record (birth and death) based on the date of registration
with the Department’s Vital Events Registry as compared to the date of data
transmittal to the CDC-National Center for Health Statistics (NCHS). This measure
calculates the percent of records received by CDC within 10 days of
registration. This measure is calculated by CDC-NCHS as data files are
transmitted to them from the Vital Events Registry. CDC compares the date of
registration of the record with DOH’s Vital Events Registry against the date
we transmit the files to the CDC. The measure has been trending upward. This
measure captures performance levels of the Vital Events Registry in
completing the registration process and transmitting the files to CDC.
Event Date Lag (%) for Birth Records
The lag
time is being measured for each birth record based on the date of birth and
the date of data transmittal to the CDC-National Center for Health Statistics
(NCHS). This measure calculates the percent of records received by CDC within
10 days of birth. This measure is calculated by CDC-NCHS as data files are
transmitted to them from the Vital Events Registry. CDC compares the date of
birth on the record against the date we transmit the files to the CDC. The
measure has been trending upward. The measure captures the performance levels
of external stakeholders responsible for reporting births in PA and the Vital
Events Registry in completing the registration process and transmitting the
files to CDC. It should be noted that the Vital Statistics Law requires the
reporting of all birth to our Birth Registry within 10 business days.
Event Date Lag (%) for Death Records
The lag time is being measured
for each death record based on the date of death and the date of data
transmittal to the CDC-National Center for Health Statistics (NCHS). This
measure calculates the percent of records received by CDC within 25 days of
death. This measure is calculated by CDC-NCHS as data files are transmitted
to them from the Vital Events Registry. CDC compares the date of death on the
record against the date we transmit the files to the CDC. The measure has
been trending upward. The measure captures the performance levels of external
stakeholders responsible for reporting deaths in PA and the Vital Events
Registry in completing the registration process and transmitting the files to
CDC. It should be noted that the Vital Statistics Law requires the reporting
of all deaths within 4 business days. This requirement has historically been
difficult to capture. However, with EDRS, we now have more insight into the
timeliness of death reporting. It should be notated that CDC plans to tighten
the timeliness in 2022. We anticipate that the timeliness standard may be
reduced to 10 days.
Number of drug overdose deaths
The
number of drug-related overdose deaths is an important measure of the
severity of the drug epidemic. Coroners and Medical Examiners regularly
provide information on overdose deaths to the Department of Health. In
2017, 5,403 people died from drug
overdose, which is the highest number of drug overdoses in PA to date. In
2018, Pennsylvania saw an 18 percent reduction in drug overdose deaths
(n=4424), followed by a less than one percent increase in 2019 (n=4458) compared
to 2018.
The COVID-19 pandemic brought unique challenges and hardships to everyone,
including the substance use and recovery communities, and preliminary
estimates as of October 2021 show a nearly 14% increase in 2020 overdose deaths
compared to 2019. 2020 also highlighted increasing trends in overdose deaths
among people of color, including a 64% increase in overdose death rates per
10,000 population among the Black community between 2018 and 2020, a 30%
increase in overdose death rates per 10,000 population among All Additional
races between 2018 and 2020, and 23% increase in overdose death rates per
10,000 population among the Hispanic community between 2018 and 2020. This signals the importance of continuing
and expanding upon existing prevention, rescue and treatment efforts, as well
as engaging people of color at every opportunity.
Preventative Health
Kindergarten immunization rate for measles, mumps, and rubella (MMR) vaccine
Getting childhood vaccinations
are key and having the required vaccines for students is critical before they
spend considerable time among their peers in communal settings. The rate of kindergarten students vaccinated
against MMR is an important measure as it demonstrates the coverage levels
for this key vaccination across the state.
As evidenced by the measles outbreak of 2019 in the United States,
having the vaccine for these highly contagious vaccine-preventable diseases
is critical. This measure is
calculated based on reports received from schools as required by 28 PA. Code
Chapter 23, Subchapter C and through the School Immunization Law Report
(SILR). Rates remain very high,
however, they did dip slightly over the last few years. This is most likely due to impacts from the
COVID pandemic and we expect the downward trend to be reversed moving
forward.
Percent of school districts with required school nurse to student ratio
This
performance measure shows the percentage of schools that are at or above the
1500:1 ratio of students to school nurses required by Pennsylvania law. The
measure is calculated by dividing a school’s Average Daily Membership by the
number of Certified School Nurses employed and has been historically trending
level in the mid to high 90 percent. Given current nursing staffing
challenges across multiple sectors, schools have experienced challenges both
recruiting and retaining school nurses. It is our belief that these numbers
may experience a slight downward trend from previous years pre-pandemic. While public schools do receive some cost
reimbursement from the commonwealth for certified school nurse positions, that
funding does not offset a majority of the cost.
Percentage of adults with obesity (Body Mass Index ≥ 30)
The percentage of adults with
obesity in Pennsylvania is being measured. It is calculated as a proportion
of adults whose body mass index is 30 or higher among all adult respondents
in the Behavioral Risk Factor Surveillance System. From 2015 to 2021, this
measure increased slightly from 30.0% to 33.3% in Pennsylvania. Obesity was
chosen because it is a complex chronic disease that is associated with heart
disease, some types of cancer, stroke, diabetes, mental health, and reduced
quality of life.
Percentage of adults with diabetes
The
percentage of adults with diabetes in Pennsylvania is being measured. It is
calculated as a proportion of adults told by their doctor that they have
diabetes among all adult respondents in the Behavioral Risk Factor
Surveillance System. From 2014 to 2022, this measure remained steady around
11 percent in Pennsylvania. Diabetes was chosen because it is the eighth
leading cause of deaths in the U.S. and can cause serious complications such
as heart disease, kidney failure, and blindness.
Percentage of children <72 months screened for lead
Percent of children under age 6
who receive at least one blood lead level (BLL) screening (venous or
capillary) during the calendar year. It is calculated using the number of
children under age 6 who receive a BLL screening during the year divided by
the estimated population of children under 6 in Pennsylvania during the year.
Each year the percentage is trending upward, except for 2020-2021 due to the
pandemic. The Department of Health recommends that all children be screened
twice by the age of 2 or at least once before age 7 if they have not
previously been tested.
Percentage children <72 months with Blood Lead Level (BLL) >5ug/dl
Percent
of children tested under age 6 with a confirmed elevated blood lead level
(EBLL) greater than or equal to 5 μg/dL, defined by the Centers for Disease
Control and Prevention as a venous BLL greater than or equal to 5 μg/dL, or
two capillary BLLs greater than or equal to 5 μg/dL within 84 days of each
other. It is calculated using the number of children under age 6 with a
confirmed EBLL divided by the number of children under age 6 tested during
the calendar year. Each year the percentage is trending downward. This will
measure if the percent of children tested with EBLLs continues to decrease.
Neonatal abstinence syndrome (per 1,000 births)
Neonatal abstinence syndrome
(NAS) is withdrawal experienced by a newborn due to in utero substance
exposure to addictive drugs. The number of NAS-related hospitalizations per
1,000 hospital births is from the HCUP Pennsylvania inpatient database. The
recent decrease may partially reflect improved non-pharmacologic treatment
and identification of fewer NAS cases using billable diagnosis codes rather
than a true NAS decrease as rates of opioid use disorder among pregnant
people remain consistent.
Rate of maternal mortality disparity between black and white persons (per 100,000 live births)
Maternal
mortality (MM) is measured by 100,000 live births and sourced from the NVSS
and Pregnancy Mortality Surveillance System, Centers for Disease Control and
Prevention for all pregnancy related deaths during or within 1 year of
pregnancy. The data is linked to live birth or fetal death certificates. MM
racial disparities exist, as Black women are 3 times more likely to
experience MM than Whites. Due to sample size, rates for MM are more reliable
when analyzed as a 3-year trend and estimates for 2018-2023 are projected
using the trend. The goal is to reduce the gap by a rate of 3 deaths per
100,000 live births over 5 years, from 2021-2025.
Rate of mortality disparity between black and white infants (per 1,000 live births)
Infant
mortality is the death of a child within the first year of life and reflects
the underlying well-being of the community and social environment. Annually,
the data that is measured by 1,000 live births, comes from the National Vital
Statistics System (NVSS) and captured in the DOH Healthy People data. The
disparity is calculated by subtracting the rates for Black and White to
identify the gap or distance between each data point. The goal to reduce the
gap by a rate of 1.5 per 1,000 live births, over 5 years, from 2021-2025.
Estimate measures are provided for 2020-2023.
Rate of mortality disparity between black and white children, ages 1-4 years (per 100,000 children ages 1-4)
Unintentional injury continues
to be the leading cause of death in children ages 1 to 4. This data is
measured by 100,000 children and is sourced annually from the NVSS with
population estimates from the U.S. Census Bureau. It is tracked and captured
using child mortality data and the DOH Healthy People data. The goal will be
to reduce this gap by a rate of 5 deaths per 100,000 children, over 5 years,
from 2021-2025. Estimate measures were provided for 2020-2023.
Percentage of newly HIV diagnosed individuals linked to care within 30 days
The
Centers for Disease Control and Prevention defines linkage to care measure as
the percentage of people receiving a diagnosis of HIV infection in a given
calendar year who had one or more documented CD4 or viral load tests within
30 days of diagnosis. For this measure, the denominator is persons receiving
a diagnosis of HIV in a measurement year, and the numerator is the number of
persons linked to care within 30 days. The National HIV/AIDS Strategy (NHAS)
2025 on improving HIV-related health outcomes of people with HIV is to
increase the proportion of persons newly diagnosed with HIV who are linked to
care within one month to 95 percent from a 2017 baseline of 77.8%. In
Pennsylvania, the proportion of individuals linked to care within 30 days of
an HIV diagnosis has increased from 77.8% in 2017 to 82.2 % in 2021. At
year-end 2021, the percentage linked to care was slightly below expected,
which may be due to the impact of the ongoing COVID-19 pandemic on HIV
surveillance, prevention, and care activities. It is estimated that at
year-end 2022 and 2023, respectively, approximately 84.3% and 85.6% of newly diagnosed individuals
will be linked to care. By year-end 2025, we estimate that about 95% of all
newly diagnosed individuals will be linked to care within 30 days of
diagnosis, meeting the NHAS goal.
Number of individuals who test HIV negative referred to Pre-exposure Prophylaxis (PrEP) services
The number of individuals who
tested HIV negative and were referred to pre-exposure prophylaxis (PrEP)
services measurement is determined by data from EvaluationWeb, a Centers for
Disease Control and Prevention sponsored database used to collect data for
HIV testing related activities that are supported by the Department of
Health, as well as data from the Department's contracted laboratory
information system. The numerator is the total number of HIV negative
individuals identified as at risk for HIV referred to PrEP and the
denominator is the total number of HIV negative individuals identified
through department-supported healthcare and non-healthcare testing. In
2021-22 there were 2,849 individuals identified as “at risk for HIV” that
were referred to PrEP. The 2022-23 estimate is 3,400 with a goal to increase
to approximately 4,200 by 2024. This measure was chosen because it is proven
that PrEP is 98 percent effective in preventing the acquisition of HIV
infection if taken according to the FDA approved requirements. By increasing
knowledge of, and referrals to, PrEP services, it is anticipated that the
number of new HIV infections would steadily decrease.
Percentage of initiation of TB treatment
Tuberculosis
(TB) is caused by a bacterium called Mycobacterium tuberculosis. TB disease
is almost always curable if treated promptly with the correct medications.
Measuring initiation of TB treatment is important to prevent TB spread.
Improving outcomes are dependent on patient compliance with direct
observation therapy services provided by Department of Health nursing staff.
Percentage of completion of TB treatment
Tuberculosis (TB) is caused by a
bacterium called Mycobacterium tuberculosis. TB disease is almost always
curable if treated promptly with the correct medications. Measuring
completion of TB treatment is important to prevent TB spread, and incomplete
therapy can lead to TB drug resistance in patients. Improving outcomes are
dependent on patient compliance with direct observation therapy services
provided by Department of Health nursing staff.
Percentage of treatment initiation of latent tuberculosis infection (LTBI) for immigrants and refugees
Tuberculosis
(TB) is caused by a bacterium called Mycobacterium tuberculosis. TB disease
is almost always curable if treated promptly with the correct medications.
Measuring initiation of latent TB treatment is important to prevent TB
spread, and incomplete therapy can lead to infectious TB. Improving outcomes
are dependent on patient compliance with direct observation therapy services
provided by Department of Health nursing staff. Many immigrants and refugees
come from countries where TB is endemic and are a special subset of
individuals who receive care.
Percentage of treatment completion of latent tuberculosis infection (LTBI) for immigrants and refugees
Tuberculosis (TB) is caused by a
bacterium called Mycobacterium tuberculosis. TB disease is almost always
curable if treated promptly with the correct medications. Measuring
completion of latent TB treatment is important to prevent TB spread, and
incomplete therapy can lead to infectious TB. Improving outcomes are
dependent on patient compliance with therapy services provided by Department
of Health nursing staff. Many immigrants and refugees come from countries
where TB is endemic and are a special subset of individuals who receive
care.
In an effort to improve completion of LTBI treatment in immigrant and
refugee populations, the TB Program has several elements in the TB
Elimination Plan developed by the newly formed TB Elimination Advisory Committee
to address this population including translating the LTBI patient fact sheet
in Chinese, Nepali, Spanish, Vietnamese, and several other languages.
Number of cases of primary and secondary Syphilis (per 100,000 population)
Syphilis is a notifiable
Sexually Transmitted Disease (STD) monitored by the Department of Health.
Through a network of a variety of STD testing sites public and private the
department monitors cases reported. The STD Program works to assure
appropriate timely treatment through the HIV/STD field staff assigned to
investigate cases. This measure reflects the total number of reported cases
of syphilis per 100,000 individuals in the National Electronic Data
Surveillance System (PA NEDSS). Currently, Primary and Secondary Syphilis is
a t a 25 year high, with the most significant increases noted in young adults
under the age of 30.
Number of cases of Gonorrhea (per 100,000 population)
Gonorrhea
is a notifiable Sexually Transmitted Disease (STD) monitored by the
Department of Health. Through a network of a variety STD testing sites public
and private the department monitors cases reported. The STD Program works to
assure appropriate timely treatment through the HIV/STD field staff assigned
to investigate cases. This measure reflects the total number of reported
cases of gonorrhea per 100,000 individuals in PA NEDSS.
Case investigation, partner elicitation, patient/partner testing and
treatment, are all efforts made to ultimately reduce transmission and reduce
the number of reported cases.
Statewide reported gonorrhea is at the highest rate in more than 25
years with young adults under the age of 30 representing approximately 63% of
the reported cases in the state.
Number of cases of Chlamydia (per 100,000 population)
Chlamydia is a notifiable
Sexually Transmitted Disease (STD). It is the most common reportable STD
monitored by the Department of Health. The department monitors cases reported
through a network of public and private STD testing sites. The STD Program works
to assure appropriate timely treatment through the HIV/STD field staff
assigned to investigate cases. This measure reflects the total number of
reported cases of chlamydia per 100,000 individuals in PA NEDSS.
Case investigation, partner elicitation, patient/partner testing and
treatment, are all efforts made to ultimately reduce transmission and reduce
the number of reported cases. In Pennsylvania, individuals under the age of
30 represent the highest burden of
disease accounting for approximately 83% of all reported cases.
Percentage of adults (age 18+) who smoke
The percentage of adults who are
current smokers in Pennsylvania is being measured. It is calculated as a
proportion of adults who reported that they were current smokers among all
adult respondents in the Behavioral Risk Factor Surveillance System. This
measure showed a declining trend from 17 percent in 2019 to 16 percent in
2020 in Pennsylvania. Smoking in adults was chosen because it is a major risk
factor for a wide range of diseases including cancer, heart disease, stroke,
and lung diseases.
Percentage of adults (age 18+) who vape
The
percentage of adults who are current users of electronic cigarettes in
Pennsylvania is being measured. It is calculated as a proportion of adults
who reported that they were current users of electronic cigarettes among all
adult respondents in the Behavioral Risk Factor Surveillance System. This
measure showed a decreasing trend from 10 percent in 2020 to 3 percent in
2021 in Pennsylvania. This measure was chosen because, despite the decrease,
vaping is still an epidemic in Pennsylvania.
Percentage of teens who smoke
The percentage of teens who are
current smokers in Pennsylvania is being measured. It is calculated as a
proportion of high school students who reported that they were current
smokers among all high school respondents in the Youth Risk Behavior
Surveillance System. This measure declined from 16 percent in 2015 to 7
percent in 2019 in Pennsylvania. This measure was chosen to understand the
prevalence of cigarette smoking among teens and to estimate future smoking
trend in adults.
Percentage of teens who vape
The
percentage of teens who are current users of electronic cigarettes is being
measured. It is calculated as a proportion of high school students who
reported that they were current users of electronic cigarettes among all high
school respondents in the Youth Risk Behavior Surveillance System. This
measure declined from 24 percent in 2015 to 18 percent in 2017, but increased
to 24 percent again in 2019. This measure was chosen because use of
electronic cigarettes increased in the country in recent years.