Workplans: A Program Management Tool
Case Study

Welcome to the Sunflower Program

The Sunflower Program is a large program that is currently offering services in 14 of its 20 counties. The population breakdown in these 14 counties is 65 percent white, 25 percent African American, and 10 percent Asian; 15 percent of the population also is Hispanic. The Sunflower Program has three urban areas and is serving approximately 10 percent of the eligible population in which most of the minority populations reside. In general, the area the program serves is considered poor and has a large number of residents who are either uninsured or underinsured at or below 200 percent of the federal poverty line (FPL).

Behavioral Risk Factor Surveillance System (BRFSS) data reveal that 91 percent of women in Sunflower have had a Pap test. The state's most recent Women's Health Survey reports that 11 percent of women below 200 percent FPL have never had a Pap test. Cancer registry and BRFSS data report that women least likely to have a Pap test are Hispanic women, older non-white women, and women of lower socioeconomic status.

The program has spent an average of 60 percent of federal funds received, improving its spending rate each year. The Sunflower Program has planned to provide 10,000 mammograms and 7,000 Pap tests per year. Last year, 5,000 mammograms and 4,000 Pap tests were completed, with 13 percent of those tests being for women who were never or rarely screened previously.

County health department coordinators are responsible for recruiting women, receiving and entering data from providers, and providing case management for clients. Local coordinators have had difficulty locating never or rarely screened women and are designing appropriate outreach activities to enroll eligible women in the program.

The Sunflower Department of Health also recruits providers and establishes and administers their contracts. Providers have been reluctant to join the program because of cumbersome reporting requirements and a lack of cancer treatment resources. Although the data submitted by providers have been accurate, they have not always been received in a timely fashion.

A review of the Data Quality Indicator Guide (DQIG) indicates that provider data meet all of the standards except follow-up of women who have normal mammograms but abnormal clinical breast exams (CBEs). During the past year, the program had appropriate follow-up of only 76 percent of women with normal mammograms and abnormal CBEs. (Only 2 percent of those who have not received appropriate follow-up are classified as lost to follow-up or refused follow-up.)

Case Study Review

Before developing a workplan for this program, it is important to outline some key information.

This can be achieved by brainstorming answers to the following questions—

• What are the strengths of this program?
• What are the areas that need improvement?

Let's apply these questions to the Sunflower Program.

What are the strengths of the Sunflower Program?

• Spending has improved consistently each year.
• Data from providers are accurate.

What are the areas that need improvement (problems)?

• Not reaching screening goals.
• Providers are reluctant to join.
• Data are not received from providers in a timely fashion.
• Low follow-up rate of abnormal findings.
• Providers feel reporting requirements are cumbersome.
• Treatment resources are lacking.

Please review the problem areas listed above and identify which ones are priorities to be focused on for the next year.

How do you determine the priority problems on which to focus?

Ask yourself these questions about the Sunflower Program—

• Do data show that this problem has had a negative impact on the success of the program?
• Has this issue been a problem for more than one year?
• Which NBCCEDP components are affected most by this problem?

Now that you've answered these questions, select three problems as priorities.

Case Study Review

What priority problems did you identify?

Three areas of focus could be—

• Low follow-up rate of abnormal findings.
• Not reaching screening goals for breast cancer.
• Not reaching screening goals for cervical cancer.

You should determine your priority problems from the most pressing needs of the program. We identified the above problems from our case study as priorities because they directly impact service to women, the Sunflower Program focus for this year.

We will now begin our discussion of the Program Planning phase of developing a workplan by learning how to set goals.