1. Dental Government Performance Results Act (GPRA) Jacqueline L. Candelaria Albuquerque Area Program Analyst

2. 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

3. 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

4. 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

5. 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)

6. 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

7. 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

8. 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

9. 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.

10. 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

11. 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

12. How is GPRA Measured

13. 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

14. 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

15. 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.

16. 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.)

17. How are you involved?

18. 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

19. 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

20. CRS National Measures displayed in iCare GPRA measures Other national measures – Categories Diabetes Dental Immunizations Cancer related Behavioral Health CVD related Other

21. 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

22. 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

23. ABQ Area GPRA Results Where we are right now

24. GPRA Results as of 3/31/2012 Dental National Measures CurrentABQ Area Current2012 National Goal General Dental Access w/in 5% of goal22.4%26.9% Dental SealantsMore than 10% from goal 13,86215,922 Topical Fluoride # of PatientsMet93148392

25. 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.

26. 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