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Dental Government Performance Results Act (GPRA)
Jacqueline L. CandelariaAlbuquerque Area
Program Analyst
What is GPRA
• Government Performance Results Act• Federal law that – Shows congress how IHS is performing based on
specific measures (9/1997-Clinton)– Has been transformed and now has budgetary
strings (Bush)– Requires a data-supported audit trail from
appropriated dollars to activities and ultimately to customer benefits/outcomes with an agency’s missions
GPRA Modernization Act of 2010
• Signed into law by President Obama on January 3, 2011– Purpose of the law• To require quarterly performance assessments of
government programs to assess agency performance and improvement• To establish agency performance improvement officers
and the Performance Improvement Council
GPRA Requirements-Federal Agencies
• Must – document their goals and progress toward goals– Have a 5-year strategic plan in place– Submit a federal government plan and report with
their budget requests
Federal Government Performance Plan
• The Plan must:– Be submitted with each budget cycle– Will be released electronically and updated at
least annually– Description of resources needed to meet the goals– Projected fiscal cost of reaching the indicator goal
as a total % of budget– How data to be reported is verified and validated
(subject to audit by OMB)
Annual Performance Report
• Must include:
– What was actually accomplished in comparison to the goals in the plan
– If goals were not met, why? – A plan for achieving unmet goals or reasons why
goal is impractical or unfeasible
Choosing Performance Measures
• All GPRA measures are determined annually by the GPRA coordinating committee with input from specific subject matter experts in various subject areas
• Emerging areas of clinical concern to IHS are proposed, discussed and refined over several months
GPRA Performance Measures-Four Main Categories
• Treatment-Diabetes, Cancer Prevention, Oral Health, etc.
• Prevention-Immunizations, tobacco usage, obesity, etc.
• Capital Programming/Infrastructure• Partnerships/Core Functions/Advocacy
Performance Measure Types• Process– Activities and health services that contribute to reducing
mortality and morbidity, e.g. clinic construction, identify disease prevalence, etc.
• Impact– Evidence based link to improved health outcomes by
reducing risk factors, e.g. immunizations; safe drinking water, cancer screening, etc.
• Outcome– Directly reduces mortality or morbidity; reduce obesity
prevalence, diabetic complications, unintentional injury, etc.
Why Is GPRA important?
• Allow for better patient care• Potentially could affect funding• Allow for site reports to be more reflective of
what is actually happening in clinics• Improve patient health-which in turn would
decrease the cost of caring for patients to allow for better quality and quantity of care
Other GPRA Requirements and Uses
• Urban facilities who receive the majority of their funding from IHS are required to report
• Tribal Facilities are not required but are highly encouraged to report– Reports are used for:• Annual budgetary requests• Program Assessment Rating Tool (PART)• Performance Audit Report (PAR)• To show effective utilization of previously appropriated
funds
How is GPRA Measured
Clinical Reporting System
• RPMS software application that produces reports on demand for GPRA and developmental clinical indicator measures based on RPMS data
• Provides automated local and Area monitoring of clinical performance in a timely manner
• Intended to eliminate the need for manual chart audits for evaluating and reporting clinical indicators
Clinical Reporting System (CRS)
• Each year an updated version of the CRS software is released to reflect changes in the logic descriptions of the different denominators and numerators and/or to add performance measures
• Logic for all facilities is identical• Ensures comparable performance data for all
facilities• Benchmarks are provided to easily identify stellar
performance-as well as opportunities for improvement
How does CRS work
• Each GPRA Indicator has one or more denominators and numerators defined.
• GPRA Indicator is translated into software logic with the assistance of clinical subject matter experts.
• Logic is based whenever possible on standard national codes– e.g., ICD-9, CPT, LOINC and national IHS standard code sets (Health
Factors, patient education codes)• CRS does a “Scavenger” hunt – utilizing taxonomies from
multiple RPMS packages to extract data from PCC looking for any code that relates to the measure
• Taxonomies contain groups of codes (e.g. diagnoses or procedures) or site-specific terms.
CRS Disclaimer
• CRS Software is not a solution• CRS Software is only a tool to assist you (and
your facility) in identifying and aggregating comparable clinical information
• CRS Software can help you identify problems (documenting care provided, coding, data entry, business processes, etc.)
How are you involved?
Critical Activities for Providers/Coders/Data Entry
• Assessing and providing care• Proper documentation of care given or refusal
of care• Accurate and complete coding• Accurate and complete data entry• Utilizing the selected indicator report and
iCare monitor process
Selected Indicator Report
• All indicator topics with all denominators and all numerators
• Displays both active clinical and user population denominators, in addition to any indicator-specific denominators
• Select one or multiple indicators or from predefined group (DM. Women’s Health, etc.)
• User can select population– AI/AN (beneficiary 01) non-AI/AN or both– User can also produce a patient list with the report
CRS National Measures displayed in iCare
• GPRA measures• Other national measures– Categories• Diabetes• Dental• Immunizations• Cancer related• Behavioral Health• CVD related• Other
Keys to Success
• Use a team Approach• Have an ongoing organization commitment• Evaluate your program throughout the year
and make changes as necessary• Share data with patients, providers, and other
clinic staff to empower them and given them a sense of ownership
GPRA Measures
• 22 IHS National GPRA Measures– 6 Diabetes related– 3 Dental related– 3 Immunizations related– 4 Cancer related– 3 Behavioral health related– 2 Cardiovascular related– 1 Other clinic related
ABQ Area GPRA ResultsWhere we are right now
GPRA Results as of 3/31/2012Dental National
MeasuresCurrent ABQ Area Current 2012 National Goal
General Dental Access
w/in 5% of goal 22.4% 26.9%
Dental Sealants More than 10% from goal
13,862 15,922
Topical Fluoride # of Patients Met 9314 8392
Sealants-Strategies for improvement
• Before patients present for appt. review what GPRA measures have not been met and encourage patients to have regular dental appointment
• Identify patients needing sealants, even adults• Provide appropriate services to patients• Replace defective or lost sealants at recall
appts.
Strategies for Improvement-continued
• Train dental assistants to replace dental sealants• Implement school-based programs (either to do
sealants or identify children through screenings with the need for sealants)
• Have dental receptionist send out postcards/letters inviting patients to the dental clinic
• Distribute information at community health fairs about the importance of dental care