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Indian Health Service: The Federal Health Program for American Indians and Alaska Natives
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Government Performance and Results Act (GPRA)

Prior to 2003, measuring GPRA performance was a labor-intensive process that required manual chart audits of medical records. In 2003, IHS switched to an electronic data collection method known first as GPRA+ and later as the Clinical Reporting System (CRS). CRS is a Resource Patient Management System (RPMS) based software package that allows IHS to collect comparable data from all participating IHS, tribal and urban sites throughout the country. In addition, it is a valuable tool to drive the improvement of health care for AI/AN people since health program staff can use the GPRA report that CRS generates to identify and target specific clinical indicators that need improvement. The CRS software also provides the ability to generate lists of patients who are in need of specific tests and screening procedures associated with each clinical indicator.

In 2003, the California Area Office (CAO) established the role of the National GPRA Support Team (NGST) and assumed a leadership role for certain GPRA activities within the Indian Health Service. The NGST is responsible for facilitating data collection and analysis from all IHS areas. In addition, the NGST assists in the preparation of the annual IHS GPRA report that is submitted to Congress as part of the budget submission. The NGST continues to work with all of the tribal and urban Indian healthcare programs in California to improve their local GPRA performance.

On January 4, 2011 President Barak Obama signed into law the GPRA Modernization Act of 2010 (GPRAMA), Public Law 111-352.  The GPRAMA strengthens the Government Performance & Results Act of 1993 (GPRA), Public Law 103-62 by requiring federal Agencies to use performance data to drive decision making.  As a result, as of FY 2013, the IHS will report six measures, which will be known as GPRAMA measures.  These six measures are:

  • Proportion of adults 18 and older who are screened for depression;
  • American Indian and Alaska Native patients with diagnosed diabetes achieve good glycemic control (A1c less than 8.0%);
  • American Indian and Alaska Native patients, 22 and older, with coronary heart disease are  assessed for five cardiovascular disease (CVD) risk factors  (Note:  the denominator for this measure is no longer patients with ischemic heart disease);
  • American Indian and Alaska Native patients, aged 19—35 months, receive childhood immunizations (4313*314);
  • 100% of hospitals and outpatient clinics operated by the Indian Health Service are accredited (excluding tribal and urban facilities);
  • Implement recommendations from tribes annually to improve the tribal consultation process.

The remaining GPRA measures will be reclassified as “budget measures” and will continue to be reported nationally in the IHS annual budget request.  The IHS will monitor our agency’s performance by quarter and report final budget measure results in the annual IHS budget request, the Congressional Justification (CJ).  Even though their designation has changed from GPRA measures to budget measures, they are still considered national performance measures.

Frequently Asked Questions

Contains answers to some of the most commonly asked questions about the Government Performance and Results Act (GPRA). 


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