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GPRAGovernment Performance and
Results Act
Mary Brickell, IT Specialist, GPRA CoordinatorPortland Area Indian Health Service
March 2012
GPRA is a Federal Law
• Government Performance and Results Act of 1993– Requires Federal agencies
to demonstrate that they are using their funds effectively toward meeting their missions.
2
• Requires a data-supported audit trail from appropriated dollars to activities and ultimately to customer benefits or outcomes consistent with an agency’s mission
$ Dollars $ (Budget
Appropriations)
Agency Mission
Health Benefits
& Outcomes
TheAudit Trail
3
History
• Portland Area Clinical Objectives– 1994 to 2004
• 17 Objectives
• GPRA+ (Aberdeen)– 2001
• IHS Clinical Reporting System (CRS)– 2002 to Present
4
History
• 2001 Started Reporting just the Federal Service Units
• 2004 Started adding a few of the larger Tribal Programs
• 2007 Added all Tribal Programs that wanted to participate
• 2012 Currently 29 Sites are included in the National report. – 2 are CHS only and are not included
5
2007 2008 2009 2010 2011
National Target 0.15 0.16 0.18 0.16 0.194
National Average 0.16 0.17 0.18 0.18 0.191
Service Unit Only 0.163 0.169 0.177 0.192 0.199
Portland Area Average 0.126 0.158 0.146 0.15 0.156
11%
12%
13%
14%
15%
16%
17%
18%
19%
20%
21%
22%
23%
24%
25%
Diabetic Poor Glycemic Control Hemoglobin A1c >9 (Results should decrease)
6
2007 2008 2009 2010 2011
National Target 0.32 0.31 0.3 0.33 0.302
National Average 0.31 0.32 0.31 0.32 0.319
Service Unit Only 0.344 0.375 0.378 0.37 0.359
Portland Area Average 0.355 0.347 0.361 0.347 0.358
26%
27%
28%
29%
30%
31%
32%
33%
34%
35%
36%
37%
38%
39%
40%
Diabetic Ideal Glycemic ControlHemoglobin A1c <7
7
2007 2008 2009 2010 2011
National Target 0.37 0.39 0.36 0.4 0.359
National Average 0.39 0.38 0.37 0.38 0.378
Service Unit Only 0.39 0.388 0.395 0.39 0.37
Portland Area Average 0.363 0.356 0.351 0.358 0.339
31%
33%
35%
37%
39%
41%
Diabetic Blood Pressure ControlBlood Pressure <130/80
8
2007 2008 2009 2010 2011
National Target 0.6 0.61 0.6 0.69 0.633
National Average 0.61 0.63 0.65 0.67 0.687
Service Unit Only 0.662 0.74 0.804 0.787 0.806
Portland Area Average 0.593 0.636 0.705 0.699 0.708
43%
48%
53%
58%
63%
68%
73%
78%
83%
88%
93%
98%
Diabetic LDL Assessment
9
2007 2008 2009 2010 2011
National Target 0 0.4 0.47 0.54 0.519
National Average 0.4 0.5 0.5 0.55 0.565
Service Unit Only 0.443 0.676 0.714 0.734 0.741
Portland Area Average 0.264 0.463 0.47 0.534 0.562
23%
28%
33%
38%
43%
48%
53%
58%
63%
68%
73%
78%
83%
88%
Diabetic Nephropathy Assessment
Base-line
10
2007 2008 2009 2010 2011
National Target 0.49 0.49 0.47 0.55 0.501
National Average 0.49 0.5 0.51 0.53 0.535
Service Unit Only 0.557 0.604 0.632 0.564 0.589
Portland Area Average 0.425 0.447 0.462 0.434 0.464
31%
34%
36%
39%
41%
44%
46%
49%
51%
54%
56%
59%
61%
64%
66%
69%
Diabetic Retinopathy Exam
11
2007 2008 2009 2010 2011
National Target 0.24 0.25 0.24 0.27 0.23
National Average 0.25 0.25 0.25 0.25 0.269
Service Unit Only 0.347 0.351 0.359 0.363 0.356
Portland Area Average 0.359 0.358 0.368 0.372 0.375
16%
19%
21%
24%
26%
29%
31%
34%
36%
39%
41%
44%
46%
49%
Dental Access
12
2007 2008 2009 2010 2011
Service Unit Only 9456 11196 11484 11148 10123
Portland Area Average 20845 23242 23715 23881 22638
6,250
8,750
11,250
13,750
16,250
18,750
21,250
23,750
26,250
28,750
Dental Sealants
13
2007 2008 2009 2010 2011
Service Unit Only 6033 6711 7307 7462 7711
Portland Area Average 13674 14483 15782 16300 17467
4,250
6,750
9,250
11,750
14,250
16,750
19,250
21,750
Topical Fluoride
14
2007 2008 2009 2010 2011
National Target 0.59 0.59 0.62 0.6 0.585
National Average 0.59 0.62 0.59 0.62 0.62
Service Unit Only 0.625 0.775 0.765 0.668 0.658
Portland Area Average 0.544 0.644 0.631 0.591 0.571
43%
48%
53%
58%
63%
68%
73%
78%
83%
88%
Influenza Vaccination 65+
15
2007 2008 2009 2010 2011
National Target 0.76 0.79 0.82 0.83 0.793
National Average 0.79 0.82 0.82 0.84 0.855
Service Unit Only 0.926 0.934 0.938 0.912 0.917
Portland Area Average 0.745 0.774 0.787 0.791 0.801
63%
68%
73%
78%
83%
88%
93%
98%
Pneumovax 65+
16
2007 2008 2009 2010 2011
National Target 0.78 0.78 0.78 0.8 0.746
National Average 0.78 0.78 0.79 0.79 0.759
Service Unit Only 0.667 0.709 0.797 0.771 0.834
Portland Area Average 0.65 0.687 0.736 0.657 0.643
53%
57%
63%
68%
73%
78%
83%
88%
93%
98%
Childhood Immunizations
17
2007 2008 2009 2010 2011
National Target 0.6 0.59 0.59 0.6 0.557
National Average 0.59 0.59 0.59 0.59 0.581
Service Unit Only 0.578 0.62 0.655 0.627 0.625
Portland Area Average 0.55 0.556 0.573 0.56 0.525
46%
49%
51%
54%
56%
59%
61%
64%
66%
69%
71%
74%
Pap Smear Rates
18
2007 2008 2009 2010 2011
National Target 0.41 0.41 0.45 0.47 0.469
National Average 0.43 0.45 0.45 0.48 0.498
Service Unit Only 0.448 0.515 0.633 0.48 0.499
Portland Area Average 0.375 0.404 0.433 0.375 0.393
26%
29%
31%
34%
36%
39%
41%
44%
46%
49%
51%
54%
56%
59%
61%
64%
66%
69%
71%
74%
Mammogram Rates
19
2007 2008 2009 2010 2011
National Target 0.22 0.22 0.29 0.36 0.367
National Average 0.26 0.29 0.33 0.37 0.417
Service Unit Only 0.449 0.551 0.586 0.574 0.597
Portland Area Average 0.295 0.347 0.371 0.381 0.411
13%
18%
23%
28%
33%
38%
43%
48%
53%
58%
63%
68%
Colorectal Cancer Screening
20
2007 2008 2009 2010 2011
National Target 0.12 0.12 0.21 0.27 0.237
National Average 0.16 0.21 0.24 0.25 0.294
Service Unit Only 0.186 0.42 0.401 0.342 0.374
Portland Area Average 0.205 0.314 0.274 0.267 0.285
1%
4%
6%
9%
11%
14%
16%
19%
21%
24%
26%
29%
31%
34%
36%
39%
41%
44%
46%
49%
Tobacco Cessation Counseling
21
2007 2008 2009 2010 2011
National Target 0.28 0.41 0.47 0.55 0.517
National Average 0.41 0.47 0.52 0.55 0.578
Service Unit Only 0.573 0.637 0.645 0.67 0.669
Portland Area Average 0.336 0.361 0.407 0.46 0.46
23%
28%
33%
38%
43%
48%
53%
58%
63%
68%
73%
Alcohol Screening for FAS Prevention
22
2007 2008 2009 2010 2011
National Target 0.28 0.36 0.42 0.53 0.528
National Average 0.36 0.42 0.48 0.53 0.553
Service Unit Only 0.586 0.615 0.624 0.643 0.641
Portland Area Average 0.37 0.365 0.388 0.416 0.434
23%
28%
33%
38%
43%
48%
53%
58%
63%
68%
73%
Domestic Violence Screening
23
2007 2008 2009 2010 2011
National Target 0.15 0.24 0.35 0.53 0.519
National Average 0.24 0.35 0.44 0.52 0.565
Service Unit Only 0.427 0.515 0.643 0.672 0.678
Portland Area Average 0.242 0.284 0.361 0.416 0.456
3%
8%
13%
18%
23%
28%
33%
38%
43%
48%
53%
58%
63%
68%
73%
Depression Screening
24
2007 2008 2009 2010 2011
National Target 0 0.3 0.3 0.33 0.33
National Average 0.3 0.3 0.32 0.35 0.398
Service Unit Only 0.293 0.28 0.244 0.219 0.349
Portland Area Average 0.223 0.216 0.217 0.201 0.303
11%
14%
16%
19%
21%
24%
26%
29%
31%
34%
36%
39%
41%
44%
46%
49%
Comprehensive Cardiovascular Disease Assessment
Base-line
25
2007 2008 2009 2010 2011
National Target 0.65 0.74 0.75 0.77 0.736
National Average 0.74 0.75 0.76 0.78 0.8
Service Unit Only 0.7 0.587 0.716 0.798 0.834
Portland Area Average 0.551 0.408 0.48 0.595 0.563
33%
38%
43%
48%
53%
58%
63%
68%
73%
78%
83%
88%
93%
98%
Prenatal HIV Testing
26
Changes for 2013
GPRA Modernization Act
27
28
GPRAMA
• January 4, 2011– President Obama signed into law
GPRA Modernization Act of 2010 (GPRAMA)– Instead of Reporting at the IHS level
performance reporting will now be at the HHS level
– All HHS operating and staff divisions report GPRAMA measures this includes IHS
– To make it manageable, HHS decreased the number of measures each OP/DIV report
29
GPRAMA
• IHS will report 6 GPRAMA Measures1. Depression Screening – 53.2%
2. Ideal Glycemic Control – 31.3%
3. CVD Assessment – 32.3%• Denominator changed from Ischemic to Coronary
Heart Disease
4. Childhood Immunizations – 74.5% (4:3:1:3:3:1:4)
30
GPRAMA
• Reported outside CRS5. 100% of IHS operated clinics are
accredited (excluding tribal and urban)
6. Implement recommendations from tribes annually to improve the tribal consultation process – 3 recommendations annually
31
GPRAMA
• Remaining GPRA measures – Reclassified as “budget measures”– Monitor performance by quarter– Clinical Measures to be reported using CRS– Continue to be reported nationally in the IHS
annual budget request and Congressional Justification
– PART and National Program Measures tracked by Headquarters
32
Other Changes for 2013
• Breastfeeding Rates – Currently only counted at Federal Service
Units– FY 2013 will report Breastfeeding Rates as an
aggregate result from both IHS and Tribal programs.
– FY 2013 will be a baseline year for this measure
33
GPRA - CRS
Nothing has changed locally• Continues to be useful reporting tool to
monitor the quality of care you are providing to your patients
• Helps to make changes in your processes and data quality
• Still required to report 2nd, 3rd and 4th quarter reports
34
More information• http://www.hhs.gov/budget/performance-appendix-fy2013.pdf link to the FY 2013 HHS
Annual Performance Report and Performance Plan.
• The 6 GPRAMA measures are on the following pages under the following HHS goals and objectives:
• Goal 1. Objective B: Improve healthcare quality and patient safety• Page 17: 100% of hospitals and outpatient clinics operated by the Indian Health Service are accredited
(excluding tribal and urban facilities). [discussion on page 19]
• Goal 1. Objective E: Ensure access to quality, culturally competent care for vulnerable populations• Page 31: Proportion of adults 18 and older who are screened for depression • Page 32: American Indian and Alaska Native patients with diagnosed diabetes achieve ideal glycemic
control (A1c less than 7.0%)• Page 32: Implement recommendations from Tribes annually to improve the Tribal consultation process
[discussion for all 3 measures begins on page 33]
• Goal 3. Objective D: Promote prevention and wellness • Page 63: American Indian and Alaska Native patients, 22 and older, with coronary heart disease are
assessed for five cardiovascular disease (CVD) risk factors [discussion on page 64]
• Goal 3. Objective E: Reduce the occurrence of infectious disease• Page 67: American Indian and Alaska Native patients, aged 19-35 months, receive childhood
immunizations [4:3:1:3:3:1:4] [discussion on page 68]
