Introduction to the 2019-2023 HPP Performance Measures Implementation Guidance

HPP and the Office of Strategy, Planning, Policy, and Requirements (SPPR) (formerly the Science Healthcare Preparedness Evaluation and Research branch) developed these performance measures (PMs). The PMs were developed to align to the core concepts of the capabilities and the FOA, to evaluate program performance, and to track program progress. Performance measurement is a component of a comprehensive program evaluation strategy that includes program monitoring and supplemental ad hoc evaluations. The new PMs will enable better communication of program results to elected officials and various internal and external stakeholders and inform continuous program improvement.

To measure HPP performance, a variety of measures were developed at the input-, activity-, output-, or outcome-level. While the HPP PMs have historically focused on program activities and outputs, these PMs further target output and outcome measures to address the information needs of various stakeholders. At a high-level, HPP stakeholders can be organized into three groups based on their information needs—national-, program-, and implementation-level. For example, at the national-level, Congress, HHS and ASPR leadership, and other national stakeholders may be most interested in the preparedness of the nation’s health care delivery system; at the program-level, HPP is interested in program effectiveness, appropriate use of funds, and identifying trends to continually improve the nation’s preparedness; and, at the implementation-level, recipients, HCCs, and individual HCOs may be most interested in how prepared they are to respond to events in their communities.

These PMs were developed based on guidance provided in the 2017-2022 Health Care Preparedness and Response Capabilities and the most recent FOA, released in March 2019. For more information on stakeholder engagement, see Appendix 1: The 2017-2022 HPP Performance Measures Development Process for more details.

Using this Document

The 2019-2023 Hospital Preparedness Program Performance Measures Implementation Guidance document is framed for the primary users—recipients and HCCs—to foster ease of comprehension, improve information aggregation, and enable faster data collection. The intended audience for this document is any individual responsible for collecting and reporting data on recipient and HCC progress toward meeting the goals of the four capabilities detailed in the 2017-2022 Health Care Preparedness and Response Capabilities. Performance measures are organized into five sections:

Section 1: Input, Activity, and Output Performance Measures

This section includes PMs 1 to 11 that gauge progress at both the recipient and HCC levels in fiscal preparedness, preparedness and response planning, identification of populations with unique needs, jurisdictional engagement, and systematic learning.

Section 2: Redundant Communications Drill Performance Measures

Each HCC will conduct a redundant communications drill (RCD) semi-annually to test redundant forms of communication among its members. This section includes PMs 12 and 13 that measure whether regular RCDs are taking place, if communication is occurring between the HCC and its members, and which platforms are being used during an RCD.

Section 3: Coalition Surge Test Performance Measures

This section contains PMs 14 to 21 that use data produced while conducting the CST. The CST is described at the beginning of section 3. To gauge the full extent of HCC performance, ASPR selected the eight PMs in this section to assess the speed and extent to which HCCs can coordinate an evacuation exercise. The eight PMs assess participation and both time- and percent-based outcomes on the ability of HCCs to coordinate patient load-sharing across the coalition.

Section 4: Joint Performance Measures

This section contains joint PMs with HPP and the Emergency Medical Services for Children (EMSC) and the Public Health Emergency Preparedness (PHEP) programs—PMs 22, J.1 and J.2. Recipients and HCCs will not report data on these PMs to HPP. EMSC and PHEP will collect this information as part of their grants and cooperative agreements and will share the data with HPP and SPPR.

Section 5: Select U.S. Territories, Freely Associated States, and Remote and Isolated Frontier Communities Performance Measures

This section contains PMs 23 to 28, which use data produced by a HST and only apply to the following U.S. Territories and Freely Associated States: American Samoa, Commonwealth of Northern Marianas, U.S. Virgin Islands, Federated States of Micronesia, Republic of Palau, and the Republic of the Marshall Islands. The U.S. Territories of Guam and Puerto Rico are not included in this category and shall report on all PMs except 23 to 28.

For the FY2019-2023 project period, HPP recognizes the unique challenges and needs of hospitals located in remote and isolated frontier communities. To improve the effectiveness of HPP funding and to reduce the burden on recipients and sub-recipients, ASPR worked with the Health Resources and Services Administration’s (HRSA) Federal Office of Rural Health Policy to categorize these hospitals and offer modified objectives, activities, and funding requirements. To be eligible for classification as a “remote and isolated frontier hospital” during the application process, hospitals must meet the following criteria:

• Be located in a geographic region within the U.S. that is classified by the U.S. Department of Agriculture’s Economic Research Service as both Frontier and Remote Area (FAR) level four, and


• Be greater than 60 miles from the next nearest hospital. It is the responsibility of the recipient to determine if a hospital located in a FAR level four locale is greater than 60 miles from the next nearest hospital.

For more information on which PMs from other sections apply to these recipients, please see the section titled Overview of Performance Measures for Select U.S. Territories, Freely Associated States, and Remote and Isolated Frontier Communities.

Performance Measure Guidance

For each PM, there is a full description of the measure and instructions on how to collect the relevant data. With the exception of EMSC and PHEP joint measures (22, J.1 and J.2), the guidance for each PM includes the following:

• Performance Measure: The section will begin with the PM number and the PM itself.
  
• Goal or Target: This section will outline the ideal or recommended result based on baseline data, benchmarks, or program requirements. In some cases, this section indicates that the goal or target may be set by SPPR at a later date after data from the initial fiscal years have been reviewed.
  
• Operational Intent: The operational intent provides a brief description of the purpose of the measure and its link to preparedness program priorities.
  
• Data Points: This section includes a table that describes the individual data points that must be reported to calculate the measure, including the data entity, data source, and response.
• Data Entity: This column will indicate organization(s) providing the data for the measure—recipient, HCC, or hospital.
• Data Source: The data source includes examples of documentation or systems where PM data are documented and managed (e.g., exercise materials, meeting notes, or financial statements). Data sources should be archived for future verification purposes.
• Response: The response column outlines the format for reporting on the required data points.
  
• Definitions and Interpretation: Specific language throughout the PM guidance is linked to a detailed definition within that section. These definitions and interpretations provide guidance on how to interpret key terms and phrases within the context of the PM.

ASPR encourages HCCs, HCOs, and other stakeholders reporting on these PMs to consult their field project officer (FPO) to receive technical assistance and resources for completing these measures.

Baseline and Target/Goal Setting

HPP and SPPR will use the data reported for initial fiscal years to establish a baseline for recipients and HCCs, unless otherwise noted in the Goal or Target section of the PM. Targets and goals will be set by SPPR based on baseline data, benchmarks, and/or program requirements. Achievement in future budget years will be determined by comparing recipients and HCCs against previously reported data and their peers or a subset of their peers, such as those sharing similar demographics, resources, and risk profiles, among other characteristics.

HPP Performance Measure Requirements

The following HPP PM requirements apply to all recipients and HCCs, except for select U.S. Territories and Freely Associated States (American Samoa, Commonwealth of Northern Marianas, U.S. Virgin Islands, Federated States of Micronesia, Republic of Palau, and Republic of the Marshall Islands) and those designated as Remote and Isolated Frontier Hospitals.

Annual Requirement to Exercise CST

All HCCs that receive HPP funding are required to conduct the CST annually (except for select U.S. Territories, Freely Associated States, and those designated as Remote and Isolated Frontier Hospitals, all of whom, besides Guam and Puerto Rico, use the HST). Data from the CST will be used to respond to PMs 14 to 21, collected using the associated evaluation tools as identified in this implementation guidance. The detailed CST manual and evaluation tools can be viewed online. In the event that an HCC has a real-world evacuation of at least 20 percent of a coalition’s total staffed acute care bed capacity during the reporting year, the HCC can use the data from the real-world evacuation to respond to each applicable PM. The HCC must still submit an After Action Report and Improvement Plan (AAR/IP) that specifically responds to each applicable PM if a real-world evacuation occurs during the reporting year.

If recipients have an equivalent exercise to the CST, they may use that exercise to meet the requirements. However, they must submit data as outlined by this document for the CST-related performance measures (PMs 14 to 21).

Optimized HCCs with Response Capabilities

HCCs must collaborate with a variety of stakeholders to ensure the community has the necessary medical equipment and supplies, real-time information, communication systems, and trained and educated health care personnel to respond to an emergency. These stakeholders include core HCC members—acute care hospitals, EMS, emergency management agencies, and public health agencies—additional HCC members, and the ESF-8 lead agency. The HCC should include a diverse membership to ensure a successful, whole community response. If segments of the community are unprepared or not engaged, there is greater risk that the health care delivery system will be overwhelmed. As such, the HCC should liaise with the broader response community on a regular basis. The list of HCC membership, delineating core and additional HCC members, is included in Appendix 2: List of Core and Additional HCC Member Types.

Overview of Performance Measures for Select U.S. Territories, Freely Associated States, and Remote and Isolated Frontier Communities

These measures only apply to the U.S. Territories of American Samoa, Commonwealth of Northern Marianas, and U.S. Virgin Islands; the Freely Associated States of Federated States of Micronesia, Republic of Palau, and Republic of the Marshall Islands; and to Remote and Isolated Frontier Communities. The U.S. Territories of Guam and Puerto Rico are not included in this category and shall report on all PMs except 23 to 28. The select U.S. Territories, Freely Associated States, and Remote and Isolated Frontier Communities have unique risk profiles, resource constraints, supply chains, and regulatory requirements compared to the rest of the recipients and HCCs receiving HPP funding.

In the following table, the reporting requirements are cross-walked to each PM: a ‘Yes’ indicates the PM shall be reported, and a ‘No’ indicates the PM is not required to be reported.

The HST will only be annually required for select U.S. Territories, Freely Associated States, and Remote and Isolated Frontier Communities. The HST is a user-friendly peer assessment designed to identify gaps in a hospital’s preparedness and help assess its ability to respond to a mass casualty event. The HST includes a low- to no-notice exercise, which incorporates the real-life considerations of health care delivery in acute care settings. The detailed CST manual and evaluation tools can be viewed online.

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