Performance Improvement 2002. Indian Health Service

01/01/2002

Mission

The mission of the Indian Health Service, in partnership with American Indian and Alaska Native people, is to raise their physical, mental, social, and spiritual health to the highest level.

Evaluation Program

The goal of the Indian Health Service (IHS) is to assure that comprehensive, culturally acceptable, personal and public health services are available and accessible to American Indian and Alaska Native people. The importance of evaluation in supporting this goal has increased significantly in recent years and includes American Indians and Alaska Natives as the primary stakeholders in defining the purpose, design, and execution of evaluations. The stakeholders use the end product of the evaluations, and are typically the population or groups most likely to be affected by the evaluation findings. The IHS has formally adopted the principles of a responsive evaluation practice to address the needs and concerns of American Indians and Alaska Natives.

The evaluation program of the IHS is managed by the Office of Public Health, Staff Office of Planning, Evaluation, and Research, which provides national leadership and consultation for IHS and Area Offices on strategic and tactical planning, program evaluation and assessment, public health and medical services, research agendas, and special public health initiatives for the Agency.

The evaluation needs of the IHS service components are coordinated using two major types of short‑term studies: policy assessments and program evaluation studies. The IHS policy assessments contribute to decision making about budget, legislation, and program modifications and include background information to support the Agency’s initiatives. Evaluation studies are focused at the program level, or Area Offices, and focus on specific program needs.

Each year IHS selects high‑priority health care and management studies for funding through the submission of proposals to headquarters and Area Offices. These proposals are reviewed and rated by a panel of subject‑matter experts, evaluation experts, and IHS staff for concurrence with IHS strategic goals, objectives, and priority areas. The proposals are then prioritized and forwarded to the IHS Director, who reviews the projects that are recommended for funding and determines the respective funding levels.

Completed Evaluations

Hyperlipidemia in Native Americans: Evaluation of Lipid Management Through a Cardiovascular Risk Reduction Program

This evaluation utilized a retrospective chart review of all patients who received treatment at least two times through the Native American Cardiovascular Risk Reduction Program at the Santa Fe Indian Hospital from March 1997 through October 1999, and who had baseline and recent LDL-C values (N=74). The program serves the Native American population of eleven Rio Grande Pueblos and urban Indians with a comprehensive CVD risk reduction program for the treatment and management of dyslipidemias, obesity, inactivity, tobacco use, diabetes, and hypertension. The program team includes licensed pharmacist clinicians and registered dieticians. The goal of the program is for patients to reach National Cholesterol Education Program guidelines through individualized treatment plans that incorporate physical activity, dietary changes, and/or the use of Simvastatin. Based on initial lipid levels and the presence or absence of diabetes, patients were classified into three LDL-C treatment groups: low risk, high risk, and highest risk. Paired t-tests were used to detect significant changes in lipid levels between baseline and follow-up within and across the three risk groups. Significant changes in lipid levels were observed in the high and highest risk groups. Over one-half (55%) of the patients reached and/or maintained their LDLl-C goal for their group.
PIC ID: 7139; AGENCY SPONSOR: Indian Health Service; CONTACT: Debbie Melton, 301-443-4700; PERFORMER: Indian Health Service, Rockville MD

In-Progress Evaluations

Evaluation of the Behavioral Risk Factor Surveillance System’s Results and Their Applicability to the Native Population of Anchorage

This study will determine the relative accuracy, validity and reliability of the Behavioral Risk Factor Surveillance System (BRFSS) risk estimates of the Anchorage Native population, compared with data collected using other techniques that include: (1) door-to-door household surveys, (2) key informant surveys, and (3) intercept data collection from Natives seeking primary care services in Anchorage from the Alaska Native Medical Center and the Primary Care Center. The analyses are revealing those particular risk factors that appear to be most significantly misrepresented by the BRFSS. This factor, combined with a more clinical analysis of those factors that pose the greatest risks to the health and well-being of the Native community, will be used in determining which questions to include on the key informant survey. Due to the nature of the survey, a relatively concise instrument is required, and only those items holding a high priority on one or both of the selection criteria (i.e., representation problems with the BRFSS and high clinical/medical risk) will be included in the key informant survey instrument.
PIC ID: 7137; EXPECTED COMPLETION: FY 2002; CONTACT: Debbie Melton, 301-443-4700; PERFORMER: Indian Health Service, Rockville MD

Alaska Native Teen Tobacco

The purpose of the Alaska Native Teen Tobacco Cessation Project is to (1) help the youth who participate in the project to quit tobacco; (2) motivate the youth to become tobacco prevention and cessation advocates in their communities; (3) determine the effectiveness of cessation camp model in helping youth to quit tobacco. If successful, further application of this model would be promoted. This is a three year project.
PIC ID: 7128; EXPECTED COMPLETION: FY 2003; CONTACT: Debbie Melton, 301-443-4700; PERFORMER: Indian Health Service, Rockville MD

American Indian Family Caregivers and the Provision of Long-Term Care

This project is intended to help develop economically feasible and culturally acceptable long-term care modalities to support Native American families in delivering care to frail elders.
PIC ID: 5940; EXPECTED COMPLETION: FY 2003; CONTACT: Debbie Melton, 301-443-4700; PERFORMER: Indian Health Service, Office of Planning, Evaluation, and Legislation, Rockville MD

Concurrent Evaluation of the Elders Clinic, a Multidisciplinary Geriatric Assessment Clinic at the Zuni-Ramah Service Unit

The purpose of this study is to describe the epidemiologic surveillance capacity of the Indian Health Design Team Indian Health Service (IHS) Provider of Health Care/Tribal Provider of Health Care/Urban Indian Program Provider of Health Care (I/T/U) system. It will also make recommendations as to how the clinical capacity could be improved to better meet the needs of the IHS and its stakeholders. This study is of increasing importance as fewer federal resources will be available to conduct epidemiologic surveillance.
PIC ID: 6741; EXPECTED COMPLETION: FY 2003; CONTACT: Debbie Melton, 301-443-4700; PERFORMER: Indian Health Service, Rockville MD

Dental Caries in Preschool Children

This project will determine the existence of a Baby Bottle Tooth Decay (BBTD) pattern among preschool children clusters in families. It will also determine if dental nutrition education to families with one child with BBTD pattern caries will reduce the rate in subsequent children. Project data will be used to determine if the utility of providing family-directed dental and nutrition education can reduce BBTD clusters in families.
PIC ID: 5531; EXPECTED COMPLETION: FY 2002; CONTACT: Debbie Melton, 301-443-4700; PERFORMER: Indian Health Service, Rockville MD

Eastern Band of Cherokee Indian Health Care Delivery System Assessment

This study will provide the Eastern Band of Cherokees with relative data on their current health care service delivery system. This data is intended for use in a re-design of the system so that it can be more responsive to all client and tribal member needs.
PIC ID: 6408; EXPECTED COMPLETION: FY 2002; CONTACT: Debbie Melton, 301-443-4700; PERFORMER: Nashville Area Indian Health Service, Nashville TN

Effectiveness of Evaluation of Systematic Implementation of Clinical Prevention Protocols for Chronic Disease Risk Reduction

This project will address health prevention and the reduction of chronic disease complications through development of a tracking system for use by the physicians and patients. This tracking system will serve as a model for tribes with health contracts.
PIC ID: 5938; EXPECTED COMPLETION: FY 2002; CONTACT: Debbie Melton, 301-443-4700; PERFORMER: Nashville Area Indian Health Service, Nashville TN

Evaluating the Effects of Medical Nutrition Therapy on Patient Outcomes Among Native Americans with Newly Diagnosed Type II Diabetes Mellitus

This study will: (1) evaluate the effectiveness of medical nutrition therapy (MNT) on clinical/behavioral outcomes in American Indians/Alaska Natives (AI/AN) with newly diagnosed Type II diabetes, (2) create a uniform methodology for collecting nutrition-oriented outcome data that is consistent among participating tribes, service units and urban programs, (3) analyze the type and amount of MNT provided with regard to patient outcomes, and (4) link this information with current clinical data from the IHS Diabetes Program which identifies Continuous Quality Improvement performance measures.
PIC ID: 6746; EXPECTED COMPLETION: FY 2002; CONTACT: Debbie Melton, 301-443-4700; PERFORMER: Indian Health Service, Rockville MD

Evaluating the Impact of Primary Intervention Techniques on the Dental Caries Rate in Children Living in Southwest Alaska Native Villages

This project will attempt to identify the reason why some communities in Bristol Bay have significantly higher/lower caries rates in children than do other children in other Bristol Bay communities. Children ages six to eight have been selected for the project, and the results of the project will be used to identify the factors that create high-risk communities. A community model will be developed for use in allocating specific resources to address the oral health needs of the villages. The primary activities will continue to be directed towards continuing intervention, which includes dental advocate services, tooth brushing, topical flouride and chemotherapy programs, distribution of children’s books, and use of the medical model for dental treatment for one to eight year olds and their mothers.
PIC ID: 7138; EXPECTED COMPLETION: FY 2002; CONTACT: Debbie Melton, 301-443-4700; PERFORMER: Indian Health Service, Rockville MD

Impact of Breast-feeding Education Program on Rates in the Early Postpartum Period and on Duration of Breast-feeding Year 2

The purpose of this project is to study the effect of a specific, planned, consistent breast-feeding education program on rates of breast-feeding initiation, and on duration of breast-feeding in the patient population. The study population includes all live births at the Claremore Indian hospital for one year from the onset of the study. The control will be a historical control, and will consist of all live births in the year prior to the onset of the study, inclusive of March 1, 1997 to April 30, 1998. During this period there were 640 live births. The goal of the study will be to reach the Healthy People 2000 goal of having 75 percent of mothers initiating breast-feeding, and keeping 50 percent breast-feeding for five to six months.
PIC ID: 7141; EXPECTED COMPLETION: FY 2002; CONTACT: Debbie Melton, 301-443-4700; PERFORMER: Indian Health Service, Rockville MD

Impact of a Structured, Comprehensive, Multi-Disciplinary Patient Education Initiative--Year 2

This study will: (1) promote wellness and prevent disease by providing comprehensive, accurate and understandable education to each patient, (2) study the impact of this multidisciplinary, planned patient education program on the health and wellness knowledge base of the patient population, and (3) document positive lifestyle/behavioral changes as a result of the education provided. The study population encompasses all American Indian/Alaska Native (AI/AN) patients eligible for care at the Service Unit (predominantly Cherokees). The Service Unit covers 12 counties in northeastern Oklahoma with 149,939 outpatient visits, accounting for 32,105 patients. This study will be submitted for publication in current medical journals by the Indian Health Service (IHS) provider. Information generated from this study will be disseminated to all tribes in the service area and all IHS facilities.
PIC ID: 7140; EXPECTED COMPLETION: FY 2002; CONTACT: Debbie Melton, 301-443-4700; PERFORMER: Indian Health Service, Rockville MD

Mental Health Service Delivery Model for Urban Native Americans: An Evaluation of Utilization Rates and Mental Health Treatment Factors

This project will address the Indian Health Service (IHS) mental health objective calling for a mental health care delivery system in urban areas. Results of the project will identify a potential model of mental health delivery applicable to urban areas.
PIC ID: 5943; EXPECTED COMPLETION: FY 2002; CONTACT: Debbie Melton, 301-443-4700; PERFORMER: California Area Indian Health Service, Sacramento, CA

Program Assessment of Co-Morbidity of Chemical Dependency Mental Health and Diabetes

The purpose of this study is to determine the outcome of simultaneous treatment of co-occurring chemical dependency, mental health issues and diabetes.
PIC ID: 7029; EXPECTED COMPLETION: FY 2002; CONTACT: Debbie Melton, 301-443-4700; PERFORMER: Indian Health Service, Rockville MD

Resource Requirements Methodology Update

This project will update the existing Resource Requirements Methodology (RRM) necessary to reflect current and future program demands of the Indian Health Service (IHS). A complete revision and documentation of the RRM will involve an update of staffing criteria and modules, formulation of a needs assessment cost model, and needs assessment model training.
PIC ID: 6450; EXPECTED COMPLETION: FY 2002; CONTACT: Debbie Melton, 301-443-4700; PERFORMER: Information and Management Technologies, Inc., Silver Spring, MD