Tribal GPRA Reporting & Best Practices: How Are We Doing?

1. Tribal GPRA Reporting & Best Practices: How Are We Doing? Alaska & USET Tribal Pilot Project Teams 2010 Annual Tribal Self-Governance Conference May 4, 2010

3. Carolyn Crowder, Aleutian Pribilof Islands Association

4. National Collaboration Alaska Tribal GPRA Pilot Project Team United South & Eastern Tribes GPRA Pilot Project Team

5. GPRA is a Federal Law • Government Performance and Results Act of 1993 • A Federal law • Requires Federal agencies to demonstrate effective use of funds towards agency mission • Measures negotiated with White House Office of Management and Budget (OMB) • Indian Health Service • 22 Clinical Measures • 14 non-Clinical measures (facilities, scholarships, etc.) • http://www.ihs.gov/NonMedicalPrograms/PlanningEvaluation/pe-gpra.asp

6. GPRA requires a Data-Supported Audit Trail from $$$$$Agency’s mission PFSAs Programs, Function, Services, Activities Appropriated $$$$ Customer Benefits & Outcomes

7. Urban Sites Are contract entities and not sovereign, so IHS requires reporting for GPRA Federal Sites Required Reporting

8. Sovereign Tribal Sites 119Tribal sites currently report GPRA GPRA Tribal Pilot Sites Chippewa-Cree Tribe of Rocky Boy's Reservation Kaw Nation Mississippi Band of Choctaw USET Alaska Voluntary Reporting

9. Why is this Relevant to Tribes

10. President Obama "….if we're going to bring real and lasting change for Native Americans, we need a comprehensive strategy, as I said before. Part of that strategy is health care. We know that as long as Native Americans die of illnesses like tuberculosis, alcoholism, diabetes, pneumonia, and influenza at far higher rates than the rest of the population, then we're going to have to do more to address disparities in health care delivery.“ Tribal Nations Conference, November 05, 2009

11. So…yes, GPRA is relevant! • Ties into budget formulation and gives OMB the tools to support $$ • Data Drives Performance Initiatives (IPC) • Demonstrates our Performance • Suicide/Meth & Domestic Violence Measures • Special Diabetes Program for Indians • Tribes GPRA Reporting Raises IHS National GPRA results

12. The Real Relevance…Healthier Communities!

13. 2010 Tribal Best Practices Conference July 25th – 28th, 2010Mystic Lake Casino Hotel Prior Lake, Minnesota • Save the date flyer – take one! • Registration available soon • Do you have a best practice to share?

15. Dr. Byron Jasper, United South & Eastern Tribes

16. Using GPRA Data beyond National Reporting Use GPRA data and associated HIT information tools (CRS & iCare) to not only improve patient care; but also, assist with local decisions making on how best to address health disparities!

17. Lessons learned from National GPRA Reporting & Chronic Care Pilots Site Success Improving Local Processes - A HIT tool (e.g., CRS & iCare) is not a solution, it must be integrated with a process (such as the IPC)! Using CRS & iCare to forecast patients needs Improved patient care by use of evidenced based best medical practices There is strong evidence from our Tribal GPRA reports that adherence with national performance measures has improved quality of care to AI/AN and has helped decrease the disease burden in Indian Country.

18. Medical Records Forecasting Process HIT Tool GPRA Forecast Sheet Patient Chart Medical Staff

19. Strengthen the PUBLIC HEALTH INFRASTRUCTURE Produce reports and provide services that assist AI/AN communities prioritize their community health improvement actions

20. Using GPRA Data beyond National Reporting Create GPRA reports and link to comparison data and cost data Develop “Fast Facts” for Tribal Leaders, Medical Staff & Community Roll-Up CRS and GPRA Measures into a Community Health Profile (CHP) Report

21. CHP Health Indicator Category Measurements • Socioeconomic factors • Mortality • Obesity • Behavioral Health (Mental/Substance Abuse) • Injury/Violence • Sexual Behaviors/STDs • Environmental Health/Quality • Immunizations • Access to Care • Cancer • Diabetes • Physical Activity • Heart Disease • Dental • Elder Care • Maternal and Child Care

22. FY2010 GPRA Measures Diabetes Glycemic control (poor & ideal) LDL Assessed Controlled BP Nephropathy Assessed Retinopathy Evaluation Dental Access to Dental Dental Sealants Topical Fluoride Immunizations Influenza Pneumovax Ever Childhood (19-35 months) Cancer Screening Pap Smear Mammogram Colorectal Cancer Screen Tobacco Cessation Behavioral Health FAS Prevention IPV/DV Screen Depression Screen Cardiovascular Disease-Related Obesity Assessment IHD: Comp CVD Other Prenatal HIV Testing

23. Using Reports to Address Health Disparities

24. Reasons to Produce CHPs Help communities monitor and address public health concerns Help establish priorities through an informed community process

26. Blood PressureControl

27. Colorectal Cancer Screening

33. The Vision - Using GPRA Data beyond National Reporting Strengthen the Public Health Infrastructure Use our Health IT systems to go beyond displaying hemoglobin A1C values…create a patient centric delivery system with an informed community. - Develop “population health reports” to improve patient care and local decisions on how best to address health disparities!

35. Karol Dixon, Jamestown S’Klallam Tribe

38. Improving Patient Care (IPC)

39. Preventing Childhood Obesity