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,  5,396 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 overdoses. Preliminary data indicates that PA had a similar number of overdose deaths in 2019 as was seen in 2018. This signals the importance of continuing and expanding upon existing prevention, rescue and treatment efforts

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).  As a very positive sign, the vaccination rate for MMR in Pennsylvania has been trending upward and looks to continue to do so 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. It is our belief that due to the recent pandemic, which has highlighted the importance of the role these certified school nurses have, this measurement will trend upwards in the future. While public schools do receive some cost reimbursement from the commonwealth for these 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 2019, this measure increased slightly from 30.0% to 33.2% 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 2019, this measure remained steady around 11 percent in Pennsylvania. Diabetes was chosen because it is the seventh 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. 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) cases reported to the state by birthing facilities and pediatric hospitals are newborns exhibiting symptoms of withdrawal due to prenatal opioid, barbiturate, or benzodiazepine exposure. Data collected prior 2018 is from billing codes pertaining to NAS-related newborn stays in PA, collected by the Pennsylvania Health Care Cost Containment Council (PHC4). In 2018, Governor Wolf’s Disaster Emergency for Opioids initiated facilities reporting of cases to DOH from the first 28 days of a newborn’s life, called rapid case ascertainment. Incidence rates declined more than 15 percent in 2019 and will reflect a smaller decline in 2020-21. NAS is associated with prematurity, low birthweight, and lengthy newborn hospital stays that cost approximately $14.1 million in 2017.
Rate of maternal mortality disparity between black and white persons (per 100,000 live births)
This data is measured by 100,000 live births. The data is sourced from the NVSS and Pregnancy Mortality Surveillance System from the CDC for all women who died during or within 1 year of pregnancy and the data is linked to live birth or fetal death certificates. Maternal mortality (MM) racial disparities exist, as Black women are 3 times more likely to experience MM than Whites. In 2016, the MM disparity rate between Black and White was 26.6. The goal is to reduce the gap by a rate of 3 deaths, over 5 years, from 2021-2025. The increase in the disparity between Black and White pregnant people in Pennsylvania between 2015-16 and 2016-17 is not clear, and nationally, during this time, an increase in pregnancy-related deaths was observed. For more information on the factors the CDC reports as possibly contributing to the increase, visit https://www.cdc.gov/reproductivehealth/maternal-mortality/pregnancy-mortality-surveillance-system.htm
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, over 5 years, from 2021-2025.
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. In 2017 the rate difference between Black and White children ages 1-4 was 11.7 deaths. The goal will be to reduce this gap by a rate of 5 deaths, over 5 years, from 2021-2025.
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 who were linked to care within 30 days. The goal of 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 70.3 % in 2014 to 81.3 % in 2019. At year-end 2020, an estimated 80.2% of all newly diagnosed HIV cases were linked to care within 30 days of diagnosis. This decrease in percentage of individuals linked to care in 2020 is most likely related to the impact of the ongoing COVID-19 pandemic on HIV surveillance, prevention, and care activities. It is estimated that at year-end 2021, approximately 83.5% of newly diagnosed individuals will be linked to care. By year-end 2025, we estimate about 95% of all newly diagnosed individuals will be linked to care, thereby 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 and the Centers for Disease Detection laboratory data entry 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. Prior to July 1, 2020, the numerator response was only collected in non-healthcare HIV testing risk counseling sessions. Beginning July 1, 2020 this response is being collected in clinical settings also. In 2019-20 there were 3,412 individuals identified as “at risk for HIV” that were referred to PrEP. The goal is to increase to approximately 4,200 by 2024. The 2020-21 estimates take into account COVID-19 mitigation efforts, which decreased client flow at healthcare and non-healthcare testing service locations and limited outreach activities. 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 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.
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, and Vietnamese.
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).
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.
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.
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 18 percent in 2015 to 17 percent in 2019 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 an increasing trend from 20 percent in 2016 to 25 percent in 2018 in Pennsylvania. This measure was chosen because more adults are starting to engage in use of electronic cigarettes.
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.