Performance Improvement 1995. Indian Health Service

02/01/1995

Listing of Abstract Titles

An Assessment of Emergency Medical Services

Evaluation of Home Care Services in the Aberdeen Area

Evaluation of Maternal and Child Health Data

Health Promotion and Aging: Improving the Understanding of Geriatric Patients Related to Medications and Their Proper Use

IHS Indirect Cost Study

Intervention Study To Influence Healthier Lifestyles Among Young Adolescent Navajo Indians

Long Term Health Projections for Alcohol Abuse-Related Hospitalizations

Report to Congress on the Indian Health Service With Regard to Health Status and Health Care Needs of American Indians in California in Response to Public Law 100-713

Use of an Alternate Model of Nursing Documentation To Increase Efficiency and Effectiveness of Patient Care Charting

TITLE: An Assessment of Emergency Medical Services

ABSTRACT NUMBER: 033

ABSTRACT: This project evaluated the Emergency Medical Service (EMS) program activities of the Indian Health Service (IHS) at national, area, and service unit levels. The project assessed how well the IHS EMS services are meeting national and applicable State standards. It identified strengths of the existing program as well as areas needing improvement. Because the same methodology has been and is being consistently applied in communities and States throughout the United States, the IHS assessment provided a useful comparison of the IHS program with those of the States. The project provided information on how EMS provided to reservation populations compared with EMS available to non-Indian rural communities. The end product is a report representing the consensus of review team members and contains detailed assessments in each of 10 specific areas. The report provides a basis on which to recommend improvements to the EMSs to meet the needs of the American Indian and Alaska Native communities.

FEDERAL CONTACT OFFICE: Office of Planning, Evaluation, and Legislation

PERSONS: Leo Nolan, Linda Arviso-Miller

PHONE NUMBER: 301/443-0416

PIC NUMBER: 5549

PERFORMER ORGANIZATION: Division of Medical Systems Research & Development, Tucson, AZ

P.I.: Peter G. Decker

TITLE: Evaluation of Home Care Services in the Aberdeen Area

ABSTRACT NUMBER: 034

ABSTRACT: This project explored issues related to home health care services in the Aberdeen [SD] Area as an alternative to hospital care and an adjunct to all other existing clinical services. The project evaluated needs as well as home care services provided by the IHS and others within the IHS system in the Aberdeen Area. The project relates to the range, quality, and appropriateness of curative and preventive services as well as broader financial and reimbursement issues. The purpose of the study was to explore the dimension of needs and the scope of existing community-based services to a specific population in the Aberdeen Area, specifically American Indians who currently receive or who would benefit from home care services. This included indivi-duals of all ages and with all types of health problems. With growing concern for cost containment and implementation of a prospective payment system, the health care industry has changed dramatically in the last 4 years. The health care literature is replete with analyses of the expansion in home care services and problems resulting from patients being discharged "quicker and sicker." These changes, coupled with technological advances, have increased the needs and demands for home care services and the types, complexity, and volume of services delivered nationally.

FEDERAL CONTACT OFFICE: Office of Planning, Evaluation, and Legislation

PERSONS: Leo Nolan, Linda Arviso-Miller

PHONE NUMBER: 301/443-0416

PIC NUMBER: 5000

PERFORMER ORGANIZATION: American Indian Health Care Association, St. Paul, MN

P.I.: Carol M. Baines

TITLE: Evaluation of Maternal and Child Health Data

ABSTRACT NUMBER: 035

ABSTRACT: The purpose of this evaluation, conducted in two parts, was to assess the availability, utilization, and quality of the Navajo Area Indian Health Service's data sets in maternal and child health (MCH). Part 1 was an assessment of the process of data collection and the perceived data needs. Interviews were conducted with service unit staff, affiliated tribal programs, IHS personnel specializing in data collection, Headquarters West, and IHS Headquarters in Rockville, among others. Findings included the following: the current MCH database does not meet the needs of clinical staff; researchers compiled a list of specific data requirements for a broad range of health parameters; there is a downward trend in multidisciplinary MCH teamwork; area offices emphasize management and finance rather than population-based health; there is no community--oriented health approach among the majority of health professions and service unit administrators; and infant and child health have become fragmented into specific pediatric initiatives. Part 2 was an assessment of the quality of an MCH data set through a comparison between computerized entries into delivery room logs and actual patient records. The congruity was high, with the exception of data on "planned pregnancies" and "anemia," supporting the validity and importance of continued integration of 15 or so most important variables into the Resource and Patient Management System. Findings are expected to increase the availability of the data to physicians and midwives nationally.

FEDERAL CONTACT OFFICE: Office of Planning, Evaluation, and Legislation

PERSONS: Leo Nolan, Linda Arviso-Miller

PHONE NUMBER: 301/443-0416

PIC NUMBER: 5544

PERFORMER ORGANIZATION: Maternal and Child Health Program, Billings, MT

P.I.: Diane Jeanotte, R.N.

TITLE: Health Promotion and Aging: Improving the Understanding of Geriatric Patients Related to Medications and Their Proper Use

ABSTRACT NUMBER: 036

ABSTRACT: This project surveyed Navajo patients' use of medications at the Chinle Service Unit and assessed the general level of patient understanding of medications. It also evaluated the effectiveness of using interactive video technology for non-English-speaking patients and those with limited English ability. Study recommendations will be helpful in assessing and improving Navajo geriatric health care. It was determined that the program for diabetic information was limited. The hardware video was bulky, ran too long, and was not practical for the major population with limited English abilities. There were no recommendations for use at other clinics in the IHS.

FEDERAL CONTACT OFFICE: Office of Planning, Evaluation, and Legislation

PERSONS: Leo Nolan, Linda Arviso-Miller

PHONE NUMBER: 301/443-0416

PIC NUMBER: 5006

PERFORMER ORGANIZATION: Headquarters East IHS, Rockville, MD

P.I.: Viola Dwight

TITLE: IHS Indirect Cost Study

ABSTRACT NUMBER: 037

ABSTRACT: This study determined the dollar amount of all IHS overhead costs, where and how money was spent, and how it was linked to the provision of direct health care. These goals were accomplished through interviews, research, and analysis of financial data. Interviews were conducted throughout the IHS organization. Interview information was compared with financial data to distinguish between overhead and direct health care. Functional analyses and cost center analyses were performed. Overhead costs for FY 1992 were calculated at 19.1 percent. Because some cost centers commingled direct and overhead costs, data obtained from individual cost centers were difficult to segregate and quantify. Cost accounting procedures were found not to be uniformly applied within IHS. Such inconsistency made it difficult to compare overhead costs among Area offices. The study proposed a refined cost center design that carefully distinguishes between overhead and direct care costs. It also offered recommendations, including timely reviews of cost center expenditures.

FEDERAL CONTACT OFFICE: Office of Planning, Evaluation, and Legislation

PERSONS: Leo Nolan, Linda Arviso-Miller

PHONE NUMBER: 301/443-0416

PIC NUMBER: 5552

PERFORMER ORGANIZATION: Native American Consultants, Inc., Washington, DC

P.I.: Joseph Tinneman

TITLE: Intervention Study To Influence Healthier Lifestyles Among Young Adolescent Navajo Indians

ABSTRACT NUMBER: 038

ABSTRACT: Approximately 1,200 seventh and eighth grade students from three junior high schools were studied for 2 school years, 1991 to 1993. Heights, weights, and a brief behavioral survey were recorded during the fall and spring of each year. At the intervention school, certificates for specific nutrition or fitness activities were completed by students and parents and collected by homeroom teachers. Homerooms competed for monetary prizes to be used for educational activities. The results for students at the intervention school were compared with those for students at the control school. A number of problems arose, some of which could be avoided in the future and some of which are intrinsic to this type of research. Teachers, administrators, parents, and students often had other commitments with higher priority, such as academic classes, exams, and athletics. Although students may have been willing to participate, some were reluctant to do something different from their peers, especially if their peers did not think it was "cool" to participate in the fitness-nutrition program. The number of students willing to participate was initially small and often inconsistent in followup responses. Distances between participating schools was great and made it difficult to achieve an impact on the students. Self-reported data, which are known from many studies to be fraught with problems, were not reliable enough to be generalizable.

FEDERAL CONTACT OFFICE: Office of Planning, Evaluation, and Legislation

PERSONS: Leo Nolan, Linda Arviso-Miller

PHONE NUMBER: 301/443-0416

PIC NUMBER: 5026

PERFORMER ORGANIZATION: Navajo Area IHS, Chinle, AZ

P.I.: Park W. Gloyd

TITLE: Long Term Health Projections for Alcohol Abuse-Related Hospitalizations

ABSTRACT NUMBER: 039

ABSTRACT: This study made long-term pro-jections for a specific disease and/or health category to determine (1) if current health and mortality patterns will continue without further scientific, treatment, or behavioral improvements and (2) the number of American Indians and Alaska Natives who will become ill or die from a specifically identified condition over the next 25 years. The study included an estimate of contributions expected from advances and innovations in current treatment and technology and changes in societal behavioral patterns, and evaluated how these contributions affected existing mortality rates and savings from eliminating medical costs and lost productivity. The study did reveal a decline in alcohol abuse; however, it was not as significant as it should have been. In fact, alcohol abuse may be worsening for women ages 55-64. Findings of the study include recommending long-term projection models that will give a truer picture of which intervention methodo-logies are most effective.

FEDERAL CONTACT OFFICE: Office of Planning, Evaluation, and Legislation

PERSONS: Leo Nolan, Linda Arviso-Miller

PHONE NUMBER: 301/443-0416

PIC NUMBER: 5034

PERFORMER ORGANIZATION: Support Services, Inc., Silver Spring, MD

P.I.: Walter Hillabrant, Ph.D.

TITLE: Report to Congress on the Indian Health Service With Regard to Health Status and Health Care Needs of American Indians in California in Response to Public Law 100-713

ABSTRACT NUMBER: 040

ABSTRACT: This study documented the health status and access to health care services of American Indians in California, especially in tribes that are not federally recognized. Through analysis of vital statistics and other databases, comparisons were made between California Indians who are members of federally recognized tribes and those who are not. On the basis of these and other comparisons, American Indians in non-federally recognized tribes in California generally had poorer health status than those in federally recognized tribes. The health status of both groups was inferior to that of other populations. For example, 6.4 percent of California Indian babies were low birthweight, whereas 5.2 percent of statewide births were low birthweight. These and related findings underscored the importance of maintaining and expanding coverage to the entire American Indian population of California. This study was coordinated with the California Area Office of the Bureau of Indian Affairs, the California Health Department, California State Indian organizations, and clinics.

FEDERAL CONTACT OFFICE: Division of Planning, Evaluation, and Legislation

PERSON: Leo Nolan

PHONE NUMBER: 301/443-4700

PIC NUMBER: 4955

PERFORMER ORGANIZATION: University of California, Los Angeles, CA

P.I.: Leila Beckwith

TITLE: Use of an Alternate Model of Nursing Documentation To Increase Efficiency and Effectiveness of Patient Care Charting

ABSTRACT NUMBER: 041

ABSTRACT: The purpose of the project was to evaluate current inpatient nursing documentation at three Billings [MT] Area hospitals and, at the option of the hospital, to evaluate a new documentation format. Two of the three hospitals chose to implement FOCUS charting, a new method that streamlines the process by requiring written notes only for abnormal patient characteristics. This method was developed by Creative Nursing Management of Minneapolis, Minnesota. The existing system relied on documentation of both normal and abnormal characteristics. The specific goals of FOCUS charting were to (1) improve the quality and content of nursing documentation; (2) facilitate inclusion of information required by certifying agencies; (3) decrease charting time; and (4) increase nursing satisfaction. The third site, Ft. Belknap, opted to keep the existing system because it is a small facility scheduled for conversion to an outpatient facility in the near future. The impact of current and new procedures was assessed via two surveys--a nursing satisfaction survey and a documentation time survey. Chart reviews were also performed at each site before and after implementation of the new documentation format. There was overall improvement with FOCUS charting, although patient education and discharge planning remained problematic. Regardless of the method, all service units successfully met documentation standards in an August 1994 survey by the Joint Commission on Accreditation of Health Care Organizations. The FOCUS chart method was permanently adopted by one of the hospitals.

FEDERAL CONTACT OFFICE: Office of Planning, Evaluation, and Legislation

PERSONS: Leo Nolan, Linda Arviso-Miller

PHONE NUMBER: 301/443-0416

PIC NUMBER: 5003

PERFORMER ORGANIZATION: IHS Billings Area Office, Billings, MT

P.I.: Jaloo Zelonis

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