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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

Abq area gpra results where we are right now
ABQ Area GPRA ResultsWhere we are right now

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