Title V Performance Measures

The Office of Title V and Family Health at the Texas Department of State Health Services greatly appreciates you taking the time to complete this survey. Your responses will inform the selection of the Title V National Performance Measures for the next five years (fiscal year 2016-2020). Federal guidance allows states to select one Performance Measure in each of the six population domains, plus two additional Performance Measures from any population domain. Please take a moment to tell us about your role in Maternal and Child Health before completing the survey. Thank you for your feedback!

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* 1. Please select the response that best describes your work setting:

City Government

State Government

Federal Government

Non-Profit Organization

Community Organization

National Organization

Hospital/Medical Facility

University/Research Institute

Other (please specify)

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* 2. Please select the response that best describes your area of focus:

Maternal and Women’s Health

Infant and Perinatal Health

Child Health

Adolescent Health

Children with Special Health Care Needs

Multiple Populations

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* 3. Please enter your work zip code:

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* 4. Please rank the following Performance Measures in the Maternal & Women's Health Domain:

Percent of women with a past year preventive visit

Percent of cesarean deliveries among low-risk first births

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* 5. Please rank the following Performance Measures in the Perinatal Health Domain:

Percent of very low birth weight (VLBW) infants born in a hospital with a Level III+ Neonatal Intensive Care Unit (Perinatal Regionalization)

Percent of infants who are ever breastfed and percent of infants breastfed exclusively through 6 months.

Percent of infants placed to sleep on their back

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* 6. Please rank the following Performance Measures in the Child Health domain:

Percent of children, ages 9 through 71 months, receiving a developmental screening using a parent-completed screening tool

Rate of injury-related hospital admissions per population ages 0 through 19 years

Percent of children ages 6 through 11 years and adolescents ages 12 through 17 years who are physically active at least 60 minutes per day

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* 7. Please rank the following Performance Measures in the Children with Special Health Care Needs domain:

Percent of children with and without special health care needs having a medical home

Percent of children with and without special health care needs who received services necessary to make transitions to adult health care

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* 8. Please rank the following Performance Measures in the Adolescent Health domain:

Rate of injury-related hospital admissions per population ages 0 through 19 years

Percent of children ages 6 through 11 years and adolescents ages 12 through 17 years who are physically active at least 60 minutes per day

Percent of adolescents, ages 12 through 17 years, who are bullied

Percent of adolescents with a preventive services visit in the last year

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* 9. Please rank the following Performance Measures in the Crosscutting or Life Course domain:

Percent of women who had a dental visit during pregnancy and percent of infants and children, ages 1 through 17 years, who had a preventive dental visit in the last year

Percent of women who smoke during pregnancy and percent of children who live in households where someone smokes

Percent of children 0 through 17 years who are adequately insured

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* 10. Other than the highest ranked Performance Measure you selected from each of the 6 domains, please select TWO additional critical measures (Texas will be selecting a total of 8 Performance Measures):

Percent of women with a past year preventive visit

Percent of cesarean deliveries among low-risk first births

Percent of very low birth weight (VLBW) infants born in a hospital with a Level III+ Neonatal Intensive Care Unit (NICU)