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Dental Government Performance Results Act (GPRA) . Jacqueline L. Candelaria Albuquerque 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)

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dental government performance results act gpra

Dental Government Performance Results Act (GPRA)

Jacqueline L. Candelaria

Albuquerque Area

Program Analyst

what is gpra
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
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
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
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
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
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
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
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
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
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
clinical reporting system
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
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
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 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.)
critical activities for providers coders data entry
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
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
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
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
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
sealants strategies for improvement
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
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
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