The Clinical Reporting System (CRS) is an RPMS (Resource and Patient Management System) software application designed for local and Area monitoring of clinical GPRA and developmental performance measures. CRS is the reporting tool used by the IHS Office of Planning and Evaluation to collect and report clinical performance results annually to HHS and to Congress. CRS is intended to eliminate the need for manual chart audits for evaluating and reporting clinical performance measures for either national or local performance reporting.
CRS contains 66 overarching clinical performance topics. Two examples of topics are Diabetic Retinopathy and Childhood Immunizations. Each topic has one or more denominators and numerators defined. The denominator is the total population that is being reviewed for a specific indicator. The numerator is the number of patients in the denominator who meet specific criteria. A performance measures is one denominator and one numerator. A GPRA performance measure is the measure defined by IHS as a specific performance measure to be reported by Congress.
Performance Measure Topic: Diabetes: Blood Pressure Control.
- GPRA Denominator: User Pop Diabetic patients, defined as User Population patients diagnosed with diabetes prior to the Report Period, AND at least 2 visits during the Report Period, AND 2 DM-related visits ever.
- Active Diabetic patients, defined as all Active Clinical patients diagnosed with diabetes prior to the Report Period, AND at least 2 visits during the Report Period, AND 2 DM-related visits ever.
- Active Adult Diabetic patients, defined by meeting the following criteria: 1) who are 19 or older at the beginning of the Report period, 2) whose first ever DM diagnosis occurred prior to the Report Period; 3) who had at least 2 DM related visits ever, 4) at least one encounter with DM POV in a primary clinic with a primary provider during the Report Period; and 5) never have had a creatinine value greater than 5.
- Patients with Blood Pressure documented during the Report Period, defined as mean of last 3 non-ER visit BP values (if 3 are not available, uses mean of 2 visits or one BP if there is only one documented);
- GPRA Numerator: Patients with controlled Blood Pressure, defined as less than 140/90, i.e., the mean systolic value is less than 140 AND the mean diastolic value is less than 90;
- Patients with BP that is not controlled, defined as any value that is equal to or greater than 140/90.
- Denominator: User Pop Diabetic patients (see detailed definition above)
- Numerator: Patients with controlled blood pressure (less than 140/90)
GPRA Measure Target:
During FY 2018, achieve the target rate of 52.3% for the proportion of patients with diagnosed diabetes who have achieved blood pressure control (defined as <140/90).
Each year, an updated version of CRS software is released to reflect changes in the logic descriptions of the different denominators and numerators. Some developmental performance measures become GPRA measures. Additional developmental measures may also be added, e.g. HEDIS.
CRS will produce reports on demand from local RPMS databases for both GPRA and developmental clinical performance measures that are based on RPMS data. Reports will display the total number in the denominator and the numerator and the percentage of patients in the numerator. CRS reports also compare the site's performance numbers in the current report period (user defined) to the previous period and to a user-defined baseline period.
In addition to the summary report, the program can produce patient lists for each measure. Administrative and clinical users will be able to review total results and lists of specific patients for individual measures at any time.
CRS reports allow users to:
- Identify potential data issues in their RPMS, e.g., missing or incorrectly coded data;
- Identify specific areas where the site is not meeting the measure in order to initiate business process or other changes;
- Quickly measure impact of process changes on measures; and
- Identify areas meeting or exceeding measures to provide lessons learned.
Sites can run reports as often as they want to and can also use CRS to transmit data to their Area. The Area Office can use CRS to produce an aggregated Area report.
CRS end users include: Area Directors, Quality Improvement staff, Compliance Officers, GPRA Coordinators, clinical staff such as physicians, nurses, nurse practitioners, and other providers, as well as any staff involved with quality assurance initiatives.