putting the pieces together – gpra, crs and education mary wachacha 2010
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Putting the Pieces Together –GPRA, CRS and EducationPutting the Pieces Together –GPRA, CRS and EducationMary Wachacha 2010Mary Wachacha 2010
GPRA is a Federal LawGPRA is a Federal Law
Government Performance and Results Act of 1993A Federal lawRequires Federal
agencies to demonstrate that they are using their funds effectively toward meeting their missions
Government Performance and Results Act of 1993A Federal lawRequires Federal
agencies to demonstrate that they are using their funds effectively toward meeting their missions
GPRA = Government Performance and Results Act
GPRA = Government Performance and Results ActGPRA is a reporting requirement for
all federal programs (including IHS)GPRA statistics go to CongressAny site that uses the RPMS is
reporting GPRA (and CRS)GPRA statistics assist in budget
formulationGPRA statistics provide an audit trail
of dollars to outcomes
GPRA is a reporting requirement for all federal programs (including IHS)
GPRA statistics go to CongressAny site that uses the RPMS is
reporting GPRA (and CRS)GPRA statistics assist in budget
formulationGPRA statistics provide an audit trail
of dollars to outcomes
GPRA Requires a Data-Supported Audit Trail
GPRA Requires a Data-Supported Audit Trail
Requires a data-supported audit trail from appropriated dollars to activities and ultimately to customer benefits or outcomes consistent with the IHS mission
Requires a data-supported audit trail from appropriated dollars to activities and ultimately to customer benefits or outcomes consistent with the IHS mission
CRS – Clinical Reporting System
CRS – Clinical Reporting System
The IHS Director has designated the Clinical Reporting System (CRS) as the national tool for reporting of all GPRA clinical measures
CRS is used within IHS to track new or emerging health problems
CRS is used internally to predict trends in health for the future
Any site that is reporting via RPMS is reporting on CRS (and GPRA)
Tribal facilities are not required to use CRS but are encouraged to use it
The IHS Director has designated the Clinical Reporting System (CRS) as the national tool for reporting of all GPRA clinical measures
CRS is used within IHS to track new or emerging health problems
CRS is used internally to predict trends in health for the future
Any site that is reporting via RPMS is reporting on CRS (and GPRA)
Tribal facilities are not required to use CRS but are encouraged to use it
Clinical Reporting System (CRS)
Clinical Reporting System (CRS)
Reports on many non-GPRA measures, includingAsthmaChronic Kidney Disease AssessmentTreatment for Upper Respiratory Infection in
Children Includes other clinical reports
Elder CareHEDISPatient EducationCMS
Reports on many non-GPRA measures, includingAsthmaChronic Kidney Disease AssessmentTreatment for Upper Respiratory Infection in
Children Includes other clinical reports
Elder CareHEDISPatient EducationCMS
Where does the GRPA and CRS data come from?
Where does the GRPA and CRS data come from?
From provider documentation: from the patient chart or the Electronic Health Record (EHR)
From provider documentation: from the patient chart or the Electronic Health Record (EHR)
Some Examples of Current GPRA Indicators
Some Examples of Current GPRA Indicators
2011 GPRA Indicators2011 GPRA Indicators
Diabetes PAP Smears Mammograms Colorectal Cancer
Screening FAS Screening
Tracked by education IPV/DV
Tracked by education
Diabetes PAP Smears Mammograms Colorectal Cancer
Screening FAS Screening
Tracked by education IPV/DV
Tracked by education
Comprehensive CVD Screening
Depression Screening Childhood Weight
Breastfeeding Rates HIV Screening Dental Tobacco Cessation Immunizations:
Flu, Pneumovax, childhood immunizations
Comprehensive CVD Screening
Depression Screening Childhood Weight
Breastfeeding Rates HIV Screening Dental Tobacco Cessation Immunizations:
Flu, Pneumovax, childhood immunizations
Let’s take a closer look at a few GPRA Indicators:
Let’s take a closer look at a few GPRA Indicators:
Tobacco Cessation
Childhood Obesity - Breastfeeding
Comprehensive CVD Assessment
Tobacco Cessation
Childhood Obesity - Breastfeeding
Comprehensive CVD Assessment
Tobacco CessationTobacco Cessation
Please note this Indicator is not about simple prevalence: Prevalence is: Do you smoke? Yes or No? Although you must ask: Do you Smoke? Yes or No?
If the patient answers “Yes” – your next step is to move the patient to cessation.
Cessation is: Patients who have received tobacco
cessation counseling: Patient Education on Tobacco Referral to a Stop Smoking Clinic Referral to a State Quit Line Prescribed cessation medications
Please note this Indicator is not about simple prevalence: Prevalence is: Do you smoke? Yes or No? Although you must ask: Do you Smoke? Yes or No?
If the patient answers “Yes” – your next step is to move the patient to cessation.
Cessation is: Patients who have received tobacco
cessation counseling: Patient Education on Tobacco Referral to a Stop Smoking Clinic Referral to a State Quit Line Prescribed cessation medications
Childhood Weight Control
Childhood Weight Control
Childhood Weight Control was replaced to a long-term measure (breastfeeding) and the new Breastfeeding Rates measure will become an annual GPRA measure.
Childhood Weight Control was replaced to a long-term measure (breastfeeding) and the new Breastfeeding Rates measure will become an annual GPRA measure.
BreastfeedingBreastfeeding
Patients 60-425 days old.Babies who have been screened for
infant feeding choice. Babies two months (60-89 days) old,
either exclusively or mostly breastfed. Babies six months (180-209 days) old,
either exclusively or mostly breastfed. Babies nine months (270-299 days) old,
either exclusively or mostly breastfed. Babies 1 year (365-425 days), either
exclusively or mostly breastfed.
Patients 60-425 days old.Babies who have been screened for
infant feeding choice. Babies two months (60-89 days) old,
either exclusively or mostly breastfed. Babies six months (180-209 days) old,
either exclusively or mostly breastfed. Babies nine months (270-299 days) old,
either exclusively or mostly breastfed. Babies 1 year (365-425 days), either
exclusively or mostly breastfed.
FEEDING CHOICE (today)
X One time data Fields
BREAST ONLY Birth Weight
(kg) Birth Order
Mostly BREASTFEEDING
Weeks/Months
½ Breastfeeding AGE – Started Formula
½ Formula
Mostly FORMULA AGE – Stopped Breast
FORMULA ONLY AGE – Started Solid Foods
Breastfeeding and Bottle Feeding
Breastfeeding and Bottle Feeding
Documenting in the Electronic Health Record
Documenting in the Electronic Health Record
Comprehensive CVD-Related AssessmentComprehensive CVD-Related Assessment
Blood Pressure value documented at least twice
With LDL completed Screened for tobacco use Body Mass Index (BMI) could be calculated
(height X weight =BMI) Received patient education:
lifestyle adaptation (LA) Medical Nutrition Therapy (MNT) Nutrition (N) Exercise (EX)
Patients with ALL assessments above.
Blood Pressure value documented at least twice
With LDL completed Screened for tobacco use Body Mass Index (BMI) could be calculated
(height X weight =BMI) Received patient education:
lifestyle adaptation (LA) Medical Nutrition Therapy (MNT) Nutrition (N) Exercise (EX)
Patients with ALL assessments above.
Examples of CRS Indicators
Examples of CRS Indicators
Other CRS Clinical Measures Topics Other CRS Clinical Measures Topics
Osteoporosis Management Osteoporosis Screening in
Women Rheumatoid Arthritis
Medication Monitoring Osteoarthritis Medication
Monitoring Asthma Asthma Quality of Care Asthma/Inhaled Steroid Use Community-Acquired
Pneumonia (CAP): Assessment of Oxygen Saturation
Osteoporosis Management Osteoporosis Screening in
Women Rheumatoid Arthritis
Medication Monitoring Osteoarthritis Medication
Monitoring Asthma Asthma Quality of Care Asthma/Inhaled Steroid Use Community-Acquired
Pneumonia (CAP): Assessment of Oxygen Saturation
Chronic Kidney Disease Assessment Pre-diabetes/Metabolic Syndrome
Medications Education Public Health Nursing Breastfeeding Rates Use of High-Risk
Medications in the Elderly Functional Status
Assessment in Elders Fall Risk Assessment in
Elders Palliative Care
Chronic Kidney Disease Assessment Pre-diabetes/Metabolic Syndrome
Medications Education Public Health Nursing Breastfeeding Rates Use of High-Risk
Medications in the Elderly Functional Status
Assessment in Elders Fall Risk Assessment in
Elders Palliative Care
Let’s take a closer look at a few CRS Indicators:
Let’s take a closer look at a few CRS Indicators:
OsteoporosisArthritisAsthmaChronic Kidney DiseaseDrugs to be Avoided in the Elderly
OsteoporosisArthritisAsthmaChronic Kidney DiseaseDrugs to be Avoided in the Elderly
Osteoporosis Management Osteoporosis Management
Female patients ages 67 and older who have a new fracture with no osteoporosis screening or treatment.
Patients treated or tested for osteoporosis after the fracture.
Fracture: Does not include fractures of finger, toe, face, or skull (i.e., pelvis, arms, leg)
Female patients ages 67 and older who have a new fracture with no osteoporosis screening or treatment.
Patients treated or tested for osteoporosis after the fracture.
Fracture: Does not include fractures of finger, toe, face, or skull (i.e., pelvis, arms, leg)
Osteoporosis Screening in Women
Osteoporosis Screening in Women
Female patients ages 65 and older without or history of osteoporosis who had osteoporosis screening
No osteoporosis diagnosis ever Osteoporosis Screening:
Central DEXA: Peripheral DEXA: Central CT: Peripheral CT: US Bone Density: Quantitative CT: Special screening for other conditions,
Osteoporosis.
Female patients ages 65 and older without or history of osteoporosis who had osteoporosis screening
No osteoporosis diagnosis ever Osteoporosis Screening:
Central DEXA: Peripheral DEXA: Central CT: Peripheral CT: US Bone Density: Quantitative CT: Special screening for other conditions,
Osteoporosis.
Arthritis MedicationsArthritis Medications
Rheumatoid Arthritis Medication Monitoring
Osteoarthritis Medication Monitoring
Rheumatoid Arthritis Medication Monitoring
Osteoarthritis Medication Monitoring
Asthma Quality of CareAsthma Quality of Care
Patients ages 5-56 with persistent asthma without a documented history of emphysema or chronic obstructive pulmonary disease (COPD)
Patients who had at least one dispensed prescription for primary asthma therapy medication
Patients ages 5-56 with persistent asthma without a documented history of emphysema or chronic obstructive pulmonary disease (COPD)
Patients who had at least one dispensed prescription for primary asthma therapy medication
Asthma and Inhaled Steroid Use
Asthma and Inhaled Steroid Use
Patients ages 1 or older who have had two asthma-related visits in ARS (Asthma Reporting System)
Patients prescribed an inhaled corticosteroid
Patients ages 1 or older who have had two asthma-related visits in ARS (Asthma Reporting System)
Patients prescribed an inhaled corticosteroid
Chronic Kidney Disease Assessment
Chronic Kidney Disease Assessment
Patients 18 and older with serum creatinine test in past year.
Patients with Estimated GFR result (lab test Estimated GFR).
A) with GFR <60
Patients 18 and older with serum creatinine test in past year.
Patients with Estimated GFR result (lab test Estimated GFR).
A) with GFR <60
Drugs to be Avoided in the Elderly
Drugs to be Avoided in the Elderly
Patients ages 65 and older – male and female
Patients who received at least one drug to be avoided in the elderly.
Patients who received at least two different drugs to be avoided in the elderly
Patients ages 65 and older – male and female
Patients who received at least one drug to be avoided in the elderly.
Patients who received at least two different drugs to be avoided in the elderly
Functional Status in Elders
Functional Status in Elders
Patients ages 55 and older, male and female Patients screened for functional status at any
time during the Report period. Functional Status: at least one of the
following Activities of Daily Living (ADL) fields: toileting, bathing, dressing, transfers, feeding, or continence
AND 2) at least one of the following Instrumental Activities of Daily Living (IADL) fields: finances, cooking, shopping, housework/chores, medications or transportation
Patients ages 55 and older, male and female Patients screened for functional status at any
time during the Report period. Functional Status: at least one of the
following Activities of Daily Living (ADL) fields: toileting, bathing, dressing, transfers, feeding, or continence
AND 2) at least one of the following Instrumental Activities of Daily Living (IADL) fields: finances, cooking, shopping, housework/chores, medications or transportation
Fall Risk Assessment in EldersFall Risk Assessment in Elders
Patients ages 65 and older, male and female Patients who have been screened for fall
risk or with a fall-related diagnosis (in the past year). A) Patients who have been screened for fall risk. B) Patients with a documented history of falling. C) Patients with a fall-related injury diagnosis. D) Patients with abnormality of gait/balance or mobility diagnosis E) Patients with a documented refusal of fall risk screening exam.
Patients ages 65 and older, male and female Patients who have been screened for fall
risk or with a fall-related diagnosis (in the past year). A) Patients who have been screened for fall risk. B) Patients with a documented history of falling. C) Patients with a fall-related injury diagnosis. D) Patients with abnormality of gait/balance or mobility diagnosis E) Patients with a documented refusal of fall risk screening exam.
Appropriate Medication Therapy after a Heart
Attack
Appropriate Medication Therapy after a Heart
Attack
Patients who have had a MI recently and need to be on medications (Heart attack) with an: Active prescription for beta-blockers. Active prescription for ASA (aspirin) or other
anti-platelet agent. Active prescription for to ACEIs/ARBs. Active prescription for to statins.
Patients have to have a prescription, refusal or a contraindication for the medication (s)
Patients who have had a MI recently and need to be on medications (Heart attack) with an: Active prescription for beta-blockers. Active prescription for ASA (aspirin) or other
anti-platelet agent. Active prescription for to ACEIs/ARBs. Active prescription for to statins.
Patients have to have a prescription, refusal or a contraindication for the medication (s)
Persistence of Appropriate Medication Therapy after a Heart
Attack
Persistence of Appropriate Medication Therapy after a Heart
Attack
People who have had a MI sin past but still need to taking these medications:AspirinBeta-blockersACEI/ARBsStatins
Patients have to have a prescription, refusal or a contraindication for the medication (s)
People who have had a MI sin past but still need to taking these medications:AspirinBeta-blockersACEI/ARBsStatins
Patients have to have a prescription, refusal or a contraindication for the medication (s)
Appropriate Medication Therapy in High Risk Patients
Appropriate Medication Therapy in High Risk Patients
Patients who are at high risk for heart disease, such as have had IHD (heart attack, heart failure, other heart problems)
Or Diabetes supposed to be taking medications:
Aspirin Beta-blockers ACEI/ARBs Statins
Patients have to have a prescription, refusal or a contraindication for the medication (s)
Patients who are at high risk for heart disease, such as have had IHD (heart attack, heart failure, other heart problems)
Or Diabetes supposed to be taking medications:
Aspirin Beta-blockers ACEI/ARBs Statins
Patients have to have a prescription, refusal or a contraindication for the medication (s)
Cholesterol Management for Patients with Cardiovascular
Conditions
Cholesterol Management for Patients with Cardiovascular
Conditions
Patients who have had 1) a heart attack, 2) heart catherization, 3) heart surgery, who have appropriate cholesterol control (LDL)
Ensure patient has their labs completed
Patients who have had 1) a heart attack, 2) heart catherization, 3) heart surgery, who have appropriate cholesterol control (LDL)
Ensure patient has their labs completed
Appropriate Treatment for Children with Upper Respiratory
Infection
Appropriate Treatment for Children with Upper Respiratory
Infection
Patients who were ages 3 months through 18 years who were diagnosed in the outpatient setting with an upper respiratory infection (URI)
Patients who were NOT prescribed an antibiotic on or within three days after diagnosis. In this measure, appropriate treatment is not to receive an antibiotic.
Patients who were ages 3 months through 18 years who were diagnosed in the outpatient setting with an upper respiratory infection (URI)
Patients who were NOT prescribed an antibiotic on or within three days after diagnosis. In this measure, appropriate treatment is not to receive an antibiotic.
Appropriate Testing for Children with PharyngitisAppropriate Testing for
Children with Pharyngitis
Patients ages 2-18 years who were diagnosed with pharyngitis and prescribed an antibiotic.
Patients who received a Group A strep test.
Patients ages 2-18 years who were diagnosed with pharyngitis and prescribed an antibiotic.
Patients who received a Group A strep test.
Improving GPRA/CRS Performance Requires a Team
Effort!
Improving GPRA/CRS Performance Requires a Team
Effort!
GPRA GPRA ResultsResults
Provider
Data Entry
IT StaffGPRA Coordinators/QI
ManagementStaff
Questions?Questions?
Contact: Contact: [email protected]
or or [email protected]
Contact: Contact: [email protected]
or or [email protected]