# Presentation: 094461

## FY2001 IHS USER POPULATION

- Janice White, MPH Dr.PH(C)
- IHS Nashville Area Office
- Statistical Officer

## Definitions

- _Indian_:
- Tribal Code = Indian or
- Tribal Designation = Unspecified _and_ Classification and/or Indian blood quantum code = Indian
- _Indian Registrants_: Total count of Indian Registrants in the IHS Patient Registration Database as of September 30, 2001. Registrants are tabulated by service unit of residence.
- _Active Indian Registrants: _Indian registrants who had at least 1 direct or contract inpatient stay, ambulatory care visit or dental visit between 10/1/98 and 9/30/2001.

## Definitions

- _Indian User Population Estimate:_ Most cases same as Active Indian Registrants. In cases where documentation for ambulatory or dental care is inadequate, the workload was seriously underreported, or there is less then 3 years of workload data for a tribe, the estimate is calculated manually based on data from other service units or an on-site sample survey.
- _IHS User Population_: # of American Indians & Alaskan Natives eligible for IHS services who have used those services at least once during the last 3 fiscal year period.

## What has changed in calculation of the IHS User Population for FY2001?

- The  definition has not changed; however
- The the following changes or improvements have been made to the data database & analysis methodology:
- Increased monitoring of data transmissions
- Re-exports of all tribal Patient Care data prior to FY2001.
- Additional re-exports of tribal Patient Care data based on multiple reviews of workload data for FY98, FY99, FY2000, FY2001.

## Changes or improvements to the IHS NPIRS data database & analysis methodology (Cont.)

- Comprehensive re-export of all tribal Patient Registration data.
- Evaluation & revision of the IHS NPIRS database and analysis database.
- New methodology for unduplication of patient records within an IHS area (not IHS wide).

## Impact of System Improvements

- Increase Data Transmission & Monitoring
- _Concerns:_ Incomplete data in NPIRS database
- _Impact:_ Varies depending on completeness of tribal export process in prior years
- Comprehensive Patient Registration Export
- _Concerns:_ 1) Errors in NPIRS software causing generation of default birthdates leading to inability to unduplicate patient records or generation of duplicate records.
- _Impact:_ Decrease due to increased ability to unduplicate records.
- _Concerns:_ 2) RPMS Software glitch causing missing or incomplete COR codes.
- _Impact:_ Increase in ability to properly identify patient as a user and the assignment of correct service unit.

## Impact of System Improvements

- Improvements to Processing
- _Concerns:_ Improper or lack of attention to prior processing caused incomplete data in NPIRS
- _Impact:_ Slight increases in workload & user populations
- Improvements to Coding
- _Concerns:_ Missing community or facility codes
- _Impact:_ Possible increase

## Impact of System Improvements

- Implementation of State of the Art Unduplication Software
- _Concerns:_ Duplicates within the area due to data entry errors. **Note: Local RPMS systems cannot account for these problems. Therefore, numbers generated in RPMS may be inflated.

## Examples of Duplications 

- Yazzie Jr. Peter 01/13/1941 123456789
- Yazzie     Peter 01/13/1941 123456789
- Gomez Nichlas   05/23/1917 123456789
- Gomez Nicholas 05/23/1917 123456789
- Gerald Christian 04/15/1924 123456789
- Gerald Christian 04/15/1924 123456789
- Gerald Christian 01/15/1924 123456789

## Impact of New Unduplication Software

**Lower but more accurate User Population numbers!**

## Other Considerations

- Expanding Service Area
- Recognition of New Tribes
- Realignment of Service Unit Boundaries
- Reporting to NPIRS
- Population Shifts due to migration
- Location & proximity of facilities
- Opening of New facilities
- Data entry lags or poor quality data entry

## Results of NAO Review of NPIRS Workload

- All workload for FY2001 were accepted upon review of tribal A-1 Workload reports except:
- _Penobscot_: No existing report to compare workload with
- _Oneida:_ Problem accessing data due to system security. Site manager out during period of review.
- _Catawba, Tunica-Biloxi & Micmac_: FY2001 data lower then expected based on tribal data.
- _Seneca:_ Not currently submitting data to NPIRS.
- _Jena Band & Mohegan_: CHS sites only. CHS transmitted data incomplete at this time. (This is true for all sites since CHS data are not due to NPIRS till April).

## Review of Proposed User Counts

- Base review on your experience with your system.
- Local RPMS reports may provide incorrect numbers due to inability to unduplicate patient records & differences in analysis programming.
- Comparison to prior years not recommended since methodology changes have been implemented. (Headquarters suggests comparison to FY1997 rather then FY1998 if one is to be made due to number of duplicates that may have occurred.)

## Procedure to Challenge IHS Proposed User Counts

- Submit request to Area Office for Review
- Request must provide strong evidence of
- Why there is a problem with the count
- Documentation of reason for undercount
- Documentation of extent of undercount (usually due to data processing problems, serious under reporting of workload, or less then 3 years of workload data in NPIRS for a tribe)
- Request will be evaluated and an On-Site Sample Survey may be conducted.
- For new tribes, an active user factor for other service units may be calculated & applied to the # of Indian Registrants to generate an estimate of Indian users.

## Review Period & Due Date

- Tribal Review Period begins now!
- Due date to Area Statistical Officer for Tribal Acceptance or Challenge:
- Friday, February 8, 2002
- Please Fax Acceptance/Challenge forms to:
- Janice White, NAO Statistical Officer
- (301) 261-4104