Improving Tobacco Indicators for GPRA

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Improving Tobacco Indicators for GPRA CRS

• Dayle Knutson, RN, BSN
• Public Health Nursing

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Brief Overview Government Performance and Results
Act (GPRA)

• Federal Statute (Law) 1993
• Funding Accountability
• Annual Performance Plan Annual Report with
  budget request
• Supports HHS Strategic Plan FY 2007-2011
• Linked to OMB Presidential Initiatives

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Impact of GPRA Measureson IHS Budget

• IHS Budget
• Goal is to meet 82 of the measures. The goal is
  equal to the met of the previous GPRA year.
• OMB considers the following during the budget
  process
• GPRA PART Performance
• Previous IHS Budget has it been flat or
  increasing?
• User Pop is it growing (more work just to
  maintain last years GPRA performance)
• Meeting GPRA measures definitely helps the
  budget!

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Relationship Between GPRA and CRS

• The IHS Director has designated the Clinical
  Reporting System (CRS) as the national tool for
  reporting of all GPRA clinical measures
• Federal (IHS) facilities are required to use CRS
  for GPRA reporting
• Urban facilities in the CAO are required to use
  CRS for GPRA reporting
• Urban facilities in other Areas are not required
  to use CRS however, more are using it because
  CRS makes reporting much easier
• Tribal facilities are not required to use CRS but
  are encouraged to use it

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Brief Overview of Clinical Reporting System (CRS)
Version 8.0

• Split into 2 separate reports National GPRA
  report Other Clinical Measures
• Patient Lists Reports will have patient lists
  where user can choose to include patients meeting
  the measure, not meeting the measure, or both
• Area Aggregate Reports Available for both the
  National GPRA ONM Reports
• Quarterly Reporting Sites will be asked to
  export data for both the National GPRA and Other
  National Measures Reports

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CRS PerformanceMeasure Terminology

• Denominator The total patient population being
  reviewed to determine how many of the total meet
  the definition of the measure
• Different measures have different denominators
• Active Diabetic patients
• Active Clinical female patients
• User Population patients

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CRS Performance Measure Terminology (contd)

• Numerator The number of patients from the
  denominator who meet the logic criteria for a
  performance measure
• Examples
• Patients with controlled blood pressure during
  the Report Period
• Patients with LDL cholesterol during the Report
  Period
• Patients with a Pap smear in the past 3 years

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CRS Performance Measure Terminology (contd)

• Performance Measure The combination of one
  denominator and one numerator
• Example Active Clinical patients 50 or older
  who have received or refused an influenza
  immunization during the Report Period
• Performance Measure Rate Calculated by dividing
  the numerator by the denominator
• Note Some performance measures are counts vs.
  rates, such as of topical fluoride
  applications, dental sealants

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CRS Performance Measure Terminology (contd)

• Performance Measure Logic The codes and
  conditions that are checked when determining if a
  patient meets the denominator and numerator
  definitions

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Tobacco Specific Measures

• Tobacco Use Exposure Assessment
• Denominators
• 1)Active Clinical patients ages 5 older,
  broken down by gender and age groups 5-13,
  14-17, 18-24, 25-44, 45-64, 65 and older (HP
  2010).
• 2)Pregnant female User Population patients
  with no documented miscarriage or abortion.

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Tobacco Specific Measures (cont)

• Numerators
• 1)Patients screened for tobacco use during
  the Report Period (during the past 20 months for
  pregnant female patients denominator).
• a) Any tobacco related Health Factor
• b) POV or PCC problem list of 305.1
  Dental Code 1320
• c) Code V15.82 (personal hx of
  tobacco use)
• d) Any patient education with TO or
  SHS indicated
• 2)Patients identified during the Report
  Period (20 months) as current tobacco users as
  documented by Health Factors
• a) Current Smoker
• b) Current Smokeless (Chew/spit
  tobacco)
• 3)Patients exposed to Environmental Tobacco
  Smoke (ETS) during the report period (20 months)

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Tobacco Specific Measures (cont)

• Tobacco Cessation/Intervention

Denominator 1)GPRA Active Clinical patients
identified as current tobacco users prior to the
Report Period, broken down by gender and age
groups lt12, 12-17, 18 and older. Numerators
1) GPRA Patients who have received or refused
tobacco cessation counseling or received a
prescription for a smoking cessation aid during
the Report Period. Documented by TO/SHS education
codes, clinic code 94, dental code 1320, CPT
codes G0375-G0376-4000F A) Patients who
refused tobacco cessation counseling.
via refusals to TO or SHS education codes. 2)
Patients identified during the Report Period as
having quit their tobacco use. Identified via
Previous Use Health Factors, POV code 305.13
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Improving Local Data

• Patient List options in CRS
• Generate list of patients not meeting indicator
  requirements/current users to case-manage for
  cessation
• Individual review/determine barriers
• Evaluate local screening process
• Evaluate local documentation process
• Implement new strategies

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Tobacco Specific Patient List

• Any user with the security key BGPZ MENU will be
  able to run the reports. Ask your Site Manager
  to assign this key to you if you do not have it.
• IHS recommends all Area and site Quality
  Improvement staff, Compliance Officers, GPRA
  Coordinators, clinical staff, and other providers
  at the local facilities as well as Area Directors
  any other staff involved with clinical quality
  improvement initiatives use CRS to run their own
  reports.

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Tobacco Specific Patient List

• Select GPRA from Menu options
• ?CIO8?RPT?LOC?
• (Community Pt Panel All)
• Selected Performance Measure 21
• Select (s)?21?Quit (q)?
• Date Prompt?Pt list prompt (yes)?Select?1?
• Tobacco Use
• P with NO documented tobacco screening
  

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Tobacco Specific Patient List (cont)

• Select GPRA from Menu options
• ?CIO8?RPT?LOC?
• (Community Pt Panel All)
• Selected Performance Measure 22
• Select (s)?22?Quit (q)?
• Date Prompt?Pt list prompt (yes)?Select?1?
• Tobacco Cessation
• Tobacco Users with Cessation Intervention,
  or
• who quit tobacco.

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Data Integrity

• Individual Chart Reviews
• -if review shows the pt did not have the
  indicator performed it confirms CRS information.
• -if review shows pt did meet the measure,
  further evaluation needs to be taken

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Data Integrity

• Incorrect ICD-9 code/CPT code used
• Not picked up by data-entry due to improper
  documentation on PCC
• Data-entry behind
• Pt. with documented refusal-not picked up by
  data-entry
• Historical Info noted but not entered

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Clinic Process Barriers

• Who completes screening documentation for
  tobacco use _at_ your facility?
• Standardized documentation process
• -reminder stamp on PCCs
• -electronic entry via E.H.R. of ed codes and
  health factors

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iCare

• Population Management software tool that helps
  you manage the care of your patients.
• The ability to create multiple panels of patients
  with common characteristics (e.g., age,
  diagnosis, community) allows you to personalize
  the way you view patient data.
• Windows-based, client-server graphical user
  interface (GUI) to the IHS Resource and Patient
  Management System (RPMS).
• Retrieves important patient information from
  various components of the RPMS database and
  brings it together under a single, user-friendly
  interface.

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iCare Cessation Case-management

• Creation of pt panels based on clinic code 94 or
  local created code
• Tobacco Cessation Performance Measures in iCare
• -cessation counseling
• -clients who have quit
• -tobacco use assessment prevalence.
• Panels can be automatically repopulated and may
  be shared with other providers

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Additional Resources

• www.ihs.gov/cio/crs/
• www.ihs.gov/CIO/ca/icare/index.asp
• www.ihs.gov/MedicalPrograms/Epi/
• www.ihs.gov/NonMedicalPrograms/NC4/Documents/Tobac
  co2-06.pdf