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Unmet Need Score (UNS) Resource Guide

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Unmet Need Score (UNS) Resource Guide Unmet Need Score (UNS) and Service Area Status (SAS) Resource Guide Description of Service Area Needs Assessment Methodology (SANAM) and Resulting UNS and SAS September 2021 U.S. Department of Health and Human Services Health Resources and Services Administration The publication was produced for the U.S. Department of Health and Human Services, Health Resources and Services Administration, under contract number 75FCMC18D0047/75R60219F80085. This publication lists non-federal resources in order to provide additional information to consumers. The views and content in these resources have not been formally approved by the U.S. Department of Health and Human Services (HHS) or the Health Resources and Services Administration (HRSA). Neither HHS nor HRSA endorses the products or services of the listed resources. Unmet Need Score (UNS) and Service Area Status (SAS) Resource Guide is not copyrighted. Readers are free to duplicate and use all or part of the information contained in this publication. Pursuant to 42 U.S.C. § 1320b-10, this publication may not be reproduced, reprinted, or redistributed for a fee without specific written authorization from HHS. Suggested Citation: U.S. Department of Health and Human Services, Health Resources and Services Administration, Unmet Need Score (UNS) and Service Area Status (SAS) Resource Guide. Rockville, Maryland: U.S. Department of Health and Human Services, 2021. Table of Contents 1 Background .............................................................................................................................................. 1 2 Description of Measures Used to Calculate the UNS .............................................................................. 2 3 Data Sources Used to Calculate the UNS .............................................................................................. 13 4 Methodology for Calculating the UNS .................................................................................................. 17 4.1 ZIP Code UNS ....................................................................................................................... 17 4.2 Service Area UNS .................................................................................................................. 19 4.3 Additional Notes on the UNS Methodology .......................................................................... 20 Appendix A Comparison of UNS 1.0 and UNS 2.0.................................................................................. 21 Appendix B Service Area Needs Assessment Methodology .................................................................... 23 Appendix C U.S. Territories and the Freely Associated States ................................................................ 27 Appendix D Service Area Status (SAS) .................................................................................................... 37 Appendix E Bibliography .......................................................................................................................... 43 Appendix F Acronyms .............................................................................................................................. 52 List of Figures Figure 1. The Measures and Measure Weights Used in the UNS Calculation ........................................... 2 Figure A-1. The Measures and Measure Weights Used in the UNS 1.0 Calculation ............................... 21 Figure B-1. Conceptual Framework for Definition of Need ..................................................................... 24 Figure C-1. The Measures and Measure Weights Used in the UNS Calculation for Puerto Rico ............ 28 Figure C-2. The Measures and Measure Weights Used in the UNS Calculation for the U.S. Territories Excluding Puerto Rico .............................................................................................................................. 29 Figure C-3. The Measures and Measure Weights Used in the UNS Calculation for the Freely Associated States ......................................................................................................................................................... 29 Figure D-1. SAS Measures and Weights .................................................................................................. 38 Figure D-2. Puerto Rico SAS Measures and Weights .............................................................................. 39 Figure D-3. U.S. Territories Excluding Puerto Rico SAS Measures and Weights ................................... 40 Figure D-4. Freely Associated States SAS Measures and Weights .......................................................... 40 List of Tables Table 1. Information for Measures Used in Calculation of UNS ................................................................ 3 Table 2. Data Characteristics for Measures Used in UNS Calculation ..................................................... 15 Table 3. Example Calculations for a Hypothetical ZIP Code UNS .......................................................... 18 Table 4. Example Calculation of a UNS for a Hypothetical Service Area with Three ZIP Codes ........... 20 Table A-1. Comparison of UNS 1.0 and UNS 2.0 Weights by Measure Group ....................................... 22 Table C-1. List of Data Sources for the U.S. Territories Excluding Puerto Rico and the Freely Associated States ......................................................................................................................................................... 32 Table C-2. Data Sources by Measure for Each U.S. Territory and the Freely Associated States ............. 35 Table C-3. Data Sources for U.S. Comparators ........................................................................................ 35 Table D-1. Example Calculation of a SAS Score for a Hypothetical Health Center Service Area with Three ZIP Codes........................................................................................................................................ 42 Table D-2. Comparison of SAS to UNS 2.0 ............................................................................................. 42 ii 1 Background This resource guide is designed to provide information on the Health Resources and Services Administration (HRSA) Service Area Needs Assessment Methodology (SANAM), a methodology that generates a quantitative assessment of an area’s unmet need for primary and preventive health care services for the Health Center Program. This guide describes how the SANAM calculates an Unmet Need Score (UNS), the measures and measure weights used in the calculation, and data sources from which the measures are derived. It also provides the conceptual model and evidence- based methodology that is incorporated into the design of the SANAM. The UNS was developed with input from stakeholders, in order to identify unmet need for primary and preventive health care services and advance health equity. The first version of the UNS was deployed in 2019 (please refer to Appendix A for additional details); this document will cover the updated UNS, version 2.0. The HRSA Health Center Program historically used a variety of methods to evaluate an area’s unmet need for primary and preventive health care services. The SANAM advances the Health Center Program’s mission to support equitable allocation of resources by applying a standard, transparent, verifiable, and automated approach to assess the primary and preventive care needs of proposed service areas. The SANAM reduces the data collection and reporting burden on health center applicants, in order to create an equitable process for all applicants. The SANAM leverages publicly available data to estimate the overall need for primary and preventive health care at the ZIP Code level,1 which allows for calculation of an UNS for any combination of ZIP Codes that health centers are proposing to serve through the addition of one or more service delivery sites. These data were selected to create a comprehensive profile of the social, economic, and health status of a proposed service area. The SANAM automates and standardizes the calculation of an UNS and facilitates assessment of unmet primary and preventive health care need across different service areas to assist the Health Center Program in targeting its resource allocation. The SANAM was designed to objectively capture aspects of need that are particularly relevant to the Health Center Program in order to contribute to the Program’s mission to provide high-quality primary health care services to the nation’s underserved and vulnerable populations. For more information on the development, testing, and selection of the SANAM measures, see Appendix B. The SANAM and resulting UNS for the 50 states and the District of Columbia is described in the main body of this resource guide. Differences in availability of data and key drivers of morbidity and mortality necessitated the development of UNS calculations specific to Puerto Rico, the other U.S. Territories, and the Freely Associated States, which are discussed in Appendix C. A use case for a modified UNS, called the Service Area Status (SAS), is discussed in Appendix D. 1 In this document, ZIP Code refers to a ZIP Code Tabulation Area (ZCTA), which is a construct of the U.S. Census Bureau to represent the U.S. Postal Service ZIP Code service area. 1 2 Description of Measures Used to Calculate the UNS The UNS is a weighted sum of measure values. For the SANAM and
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