Trends in Indian health - 1991.

Update of the 2003 IHS Strategic Plan Includes mortality,disparities rate

Indian Health Service Strategic Plan 2006-2011

This Indian Health Service (IHS) publication attempts to fulfill the basic statistical information requirements of parties interested in the IHS, and its relationship with the American Indian and Alaska Native (AI/AN) people. The tables and charts describe the IHS program, and the health status of American Indians and Alaska Natives. Information pertaining to the IHS structure, and American Indian and Alaska Native demography and patient care are included. Regional differences are depicted, and comparisons to the general population are made, when appropriate. The tables and charts are grouped into five major categories: (1) IHS structure, (2) population statistics, (3) natality and infant/maternal mortality statistics, (4) general mortality statistics, and (5) patient care statistics

IHS Capital Financing and Health Care Reform

This document is the primary publication of a 1984-1986 management review of the Indian Health Service (IHS)-sponsored alcohol programs serving American Indians and Alaska Natives. The IHS Alcoholism/Substance Abuse Prevention Initiative: Background, Plenary Session, and Action Plan is the manifesto of the alcohol/substance abuse programs for the future. The overall purposes of the review were: 1) to define the scope of alcohol treatment and prevention efforts at all levels; 2) to identify existing program strengths; 3) to identify unique approaches to be considered for broader application; 4) to identify deficiencies; 5) to set forth the actual steps to remedy the deficiencies; and 6) to make recommendations for the mission and future direction of the IHS and alcoholism program efforts. The Background section is designed to expose the trends and issues affecting the alcoholism programs prior to 1984. The Plenary Session documents the proceedings of the second stage of the alcoholism programs management review. The Action Plan is a presentation of the recommendations developed by the contributors in the plenary session. The Action Plan was designed to address all of the relevant managerial functions, including planning, standards setting, monitoring, evaluation, resource management, operations, coordination, research, and training. The complete document provides the rationale, structures, and strategies necessary to chart a new direction that will demand enhancement of treatment program effectiveness and a realignment of resources in response to advancements in institutional knowledge and experience.This document comprises the published results of a management review of the IHS alcoholism programs that was requested by the Director of the IHS, Everett R. Rhodes, M.D., and initiated in the summer of 1984. Participants in this comprehensive program review included: 1) tribal leader representatives from each area; 2) alcohol program representatives from each area or program office; 3) IHS area alcoholism coordinators; 4) IHS line and staff officials; 5) individuals knowledgeable in the field of alcohol/substance abuse but not directly connected to IHS or tribal programs; and 6) 30 individuals from the outside who expressed interest in contributing to the process. The three major tasks of the reviewers were to: 1) develop a briefing book; 2) complete a plenary session with a set of recommendations; and 3) develop and gain the approval for an action plan based upon the recommendations coming out of the plenary session.The Director, IHS, asserted that many IHS physical plants were currently inappropriate for providing alcohol services. He concluded that these problems are solvable. In addition, he called for better horizontal and vertical communications between and within the IHS health care system and the alcohol programs. Various IHS staff, substance abuse program professionals, Federal officials, researchers, and academicians contributed their perspectives on the future direction of alcohol prevention and treatment efforts in the American Indian community. Highlights of these perspectives included: 1) community-based programs and coordination with other agencies; 2) the need for both residential and outpatient treatment services; 3) tribal leadership involvement in the recognition of alcohol as a problem; 4) good professional education for IHS doctors and nurses; 5) the importance of standardized recordkeeping for the purposes of comparison and evaluation; 6) the use of traditional healers; 7) the need to provide incentives for those programs that excel, and the continued support for those that do not function well or at all; 8) the emphasis on culture to the success and failure of different programs; 8) identification of generalizable attributes associated with the success of alcoholism prevention efforts among American Indians; and 9) the view of alcoholism as a psychosocial medical disease requiring an holistic approach to treatment.The Action Plan was developed with the assistance of the information disseminated during the Plenary Session. Specific activities, and a specific timeline for their implementation, were itemized for all nine essential management functions (listed above). Specific recommendations focused on managing scarce resources, finding additional resources, focusing on prevention, targeting youth and women for prevention activities, improving training for IHS professionals and staff to incorporate a clear understanding of alcoholism as a disease and to heighten cultural awareness. A management information system was initiated as a result of this review, and research priorities were established. Also, a plan was outlined to facilitate the monitoring of programs, and establishing a system for supporting the demands of the evaluation process. A persistent recommendation appearing throughout the review was the need to bring tribal governments into all facets of IHS involvement in alcoholism treatment and prevention, and to find ways to further involve Congressional delegates in the process

Alaska Area Native Health Service: description of the program.

This publication is intended to provide information on the health status of the Alaska Native people and the related programs offered by the Alaska Area Native Health Service

Regional differences in Indian health - 1997

This study (1) determined the present health status of the urban Indian population in the State of Arizona, and determined the extent of use and availability of all health resources for that population, (2) identified the health needs of the population and the barrier\\u27s that exist in addressing those needs, and (3) provided accurate and timely information that will serve as an objective base for decision making in addressing the identified needs and problems.A needs assessment approach was used with an overall framework represented by the model: Health Status (minus-) Health Resources Used (plus+) Barriers/Health Resources Not Used (equals=) Health Needs. The study also incorporated the PRECEDE model developed by Lawrence Green of the University of Texas and the Needs Assessment for Prevention Planning developed by the Alcohol, Drug Abuse and Mental Health Administration of the PHS. The study used data compiled on the Phoenix Service Unit for Phoenix and the Pima County urban census tract mortality data for Tucson. Interview data and other sources were also used.The health status of urban Indians in Arizona is poor, and three of the six major causes of death - accidents, alcoholism, homicide - are complex problems with which medical technology has had little success. Heart disease, cancer and diabetes, the other leading causes of death are chronic conditions requiring long-term health monitoring. Urban Indian reported high prevalence of vision problems (40.5%), overweight (37.3%), dental (30.7%), and back problems (21.7%). Mental health problems affected many in the Indian community - 14.5% reported anxiety and depression and 13.5% reported fatigue and exhaustion. Infant mortality rates for urban Indians are well above the rate of the Arizona general population and the overall Arizona Indian population. The urban Indian infant mortality rate exceeds the 1990 U.S. Surgeon General\\u27s Objective for the nation by 60%. Health risk factor levels are high among the Arizona urban Indian community. High blood pressure readings in the Indian males combined with the low numbers taking blood pressure medication point to the importance of screening and follow-up for heart health risks. Levels of obesity, binge drinking and diabetes are also elevated within the urban Indian community in Arizona. Other health risks of urban Indians include high driving speeds, driving while intoxicated, and sedentary life-styles. The major source of health care for urban Indians is the IHS. Other sources such as county medical facilities, community health centers, and private providers are rarely used. Over 40% of the urban Indian community went to the emergency room for health care during 1988. However, many of these visits represent inappropriate use of the emergency facilities. Social services in the metropolitan areas are under-utilized by the Indian community. Indian-specific programs with the exception of alcohol-related services and Women, Infants, and Children (WIC) nutrition services are not available. Both WIC and the alcohol-related programs are among the few used by the Indian community, indicating that services geared toward Indian people will have greater utilization than those not culturally specific. American Indians living in urban areas with limited access to phones and transportation are best reached by the word-of-mouth about services. American Indian staff in urban health programs, particularly the Community Health Representatives, provide an important link to the urban Indian community. They are able to outreach through their work in both homes and community health. They can follow the movement of clients through their family and friends within the community. Most of the urban health programs provide transportation services that enable urban Indians to access services they would otherwise forego. Barriers to care were identified in the categories of socioeconomic factors, lack of health insurance, complexity of Medicaid program requirements, limited availability of services for low-income Indians in urban areas, and limited accessibility and acceptability of services for urban Indians. The combination of poor health status, underutilization of services, and numerous barriers to services leave the urban Indian community with service requirements for medical items, prescriptions, emergency care, pediatric care, and overnight hospital stays. In addition, culturally sensitive mental health programs are needed based on the high prevalence of anxiety, depression, and exhaustion within the community. There is a critical need for basic preventive, family-centered medical services, and for comprehensive perinatal care. Because of the high number of young children, there is a great need for well-child clinics focusing on preventive medicine. Clinics providing culturally-specific services need to be incorporated into the health plan for the urban Indian community. Low-cost ambulatory clinic facilities with eye and dental care are needed. Prevention programs targeting diabetes, alcohol and drug abuse, sexually transmitted diseases, violence, and accidental injuries should be established to assuage the high costs of such conditions among urban Indian communities in Arizona. Transition programs for new residents in each urban area would help bring Indians into the service stream and avoid the downward spiral into despairing poverty. Indian-specific mental health services are needed to deal with the high rate of homicide and suicide among Indian youth, the high rates of alcohol and substance abuse, and reported mental health problems. In policy terms, there is a need for a Medicaid education program and a coalition of efforts among the tribes, IHS, state, and private agencies. Arizona should be addressed as a contract care state since legislation has been already passed; but no funding has been allocated to carry out the legislation. The role of the Phoenix Indian Medical Center needs to the clarified to establish whether it functions as a referral hospital (as originally intended) or as an outpatient clinic (as it is currently utilized but without adequate resources). The IHS needs to explore the feasibility of shared service in Arizona between urban Indian health care delivery programs and local service units. Full-time urban Indian positions at the state and federal levels need to be established

Benchmarking Home Health Care and Public Health Nursing Services

Purpose The Billings Area Indian Health Service (IHS) serves approximately 60,021 American Indians living in Montana and Wyoming. For many eligible American Indians in the Billings Area, home health care services are not available. The aims of this project are: 1) develop a current profile of existing public health nursing and home health care services on each reservation in the Billings Area IHS; 2) develop a profile of successful home health programs on reservations in the United States; and 3) integrate the two profiles to identify factors contributing to success and failure in home care programs. Methods Benchmarking, a key tool in Total Quality Management (TQM), was used in this project. Several phases are undertaken in a benchmarking process: planning, analysis, integration, action, and maturity. This project focused on the first three phases. Initially, the project team decided what to benchmark - skilled home health care. Next, profiles of the eight Billings Area IHS Service Units were developed. The project team then visited four sites across the U.S. where tribes provided home health care services to tribal members with partner agencies. Results The user populations of the Billings Area Service Units range from 3,700 to 10,400. The proportion of the population that is elderly has been used as an indicator of home health care need. The populations are relatively young with a high percentage of residents under age 5 and a relatively low percentage of residents over the age of 55. The leading causes of persons using home health care include heart disease, musculoskeletal disease, injuries and poisoning, cancer, respiratory disease and endocrine disorders. The availability of home health care resources on the Service Units varies widely. All Billings Service Units have public health nursing services, however, most the Public Health Nurses are only able to provide minimal home health care services. Tribal home health care partnerships developed by Fort Belknap in Montana, Cherokee Nation in Oklahoma, and the Navajo Nation in New Mexico, were reviewed with respect to service agreements, clients, and budget implications. Conclusion For any new skilled home health care service venture to be successful, the following components must be present: 1) commitment; 2) support; 3) communication; 4) leadership; and 5) autonomy. Prior to implementing a strategy of home health care services, several issues must be considered. These issues include: 1) size of service population; 2) geographic location of service population; 3) availability of collaborator agencies; 4) availability of skilled home health care professionals; 5) administrative capacity; 6) technology infrastructure 7) tribal support; and 8) community networks

Reauthorization of the Indian Health Care Improvement Act

Purpose The purposes of this publication are to: 1) recognize and publicize outstanding examples of the application of managed care principles to direct care services in Indian health programs; 2) stimulate other innovative Indian Health Service (IHS) and tribal management efforts; and 3) demonstrate to others that IHS and tribal health programs have a commitment to managed care. Methods Experiences with managed care in Indian health programs are documented in this monograph. Specific program examples are provided from the following areas of the IHS: 1) Alaska Area; 2) Albuquerque Area; 3) Aberdeen Area; 4) Billings Area; 5) California Area; 6) Headquarters West; 7) Nashville Area; 8) Navajo Area; 9) Oklahoma City Area; and 10)Portland Area. Results The tools of managed care include utilization review, case management, provider contracting, and information technology. Applications of managed care principles reviewed in this monograph include: 1) pharmaceutical costs; 2) tribal program management; 3) mental health services; 4) telemedicine; 5) cancer screening services; 6) electronic clinical record; and 7) teleradiology. Conclusion Managed care flexibility provides a dynamic process for developing a cost-effective, high quality health care delivery system tailored to meet the very specific and unique needs of the American Indian and Alaska Native populations. The challenge to those involved in the delivery of health care to American Indians and Alaska Natives is to develop strategies to ensure the delivery of cost-effective, high quality health care

The use of a MED calendar to increase medication compliance

This study describes the successful design and implementation of a medications calendar to increase medication compliance among Navajo patients who have difficulty complying with prescription instructions. This paper is presented as an example of a successful method for trying to ensure that medications are taken according to instructions. The MED calendar is designed to help non-English speaking and elderly patients in particular.Initially the calendars were hand made by the drivers from the Public Health Nursing Department. Their primary duty was to serve as interpreters for the Public Health Nurse. Poster board (20 x26 ) was used to simulate a monthly calendar. The days of the week were marked on each grid on each board. The boards were then laminated and the laminated surface was used to mark the name and days of the month for which the calendar was being used. The patients medications were then placed in single unit dose packages. The dose packages were then taped to the calendar according to the prescribed schedule. The patient then received a detailed verbal explanation on when and how to take his or her medicine. The calendar was attached to the wall of the patient\\u27s residence with stick pins and medications were placed for 2-4 weeks at a time. The material cost of the original calendars was $1.75 without labor. Now a professional printer produces them at a total cost of$3.00 per unit. There were two primary safety considerations explored with the implementation of the MED calendars. The first was concern for the stability of the medication in a clear package as opposed to opaque bottle. The Chief of Pharmacy indicated that medicine can be kept in unit dose packages up to six months. The benefits of patient compliance were much greater than any small risk of medication instability. The second concern was safety around small children. In most cases the calendar can be placed high enough on the wall to be out of reach of the children. If this is not possible then the use of the MED calendar is not considered.MED calendars were well accepted by the patients. Navajo patients relate well to ordinary monthly calendars, and this does not require knowledge of the English language. Also, the calendars are highly visible making them difficult to ignore. Medication doses are more easily understood with a pictorial association. The calendars are durable and last at least two or three years. From 1985 to 1987, the MED calendars were used with non-compliant patients. Seventy-three percent of the patients showed some improvement. Improvement was measured by 1) improvement in clinical symptoms including decreased hospitalization, 2) accurate or improved pill count, and 3) patient\\u27s and/or doctor\\u27s affirmation of compliance. There are several difficulties noted in the use of the MED calendar. Safety in the presence of small children is a major concern. Some patients become very dependent on the MED calendar, and this becomes time consuming for the Public Health Nurse who must visit every 2-4 weeks to refill the unit dose packages. Sometimes the unit dose packages do not remain secured to the calendar. Finally, the large size of the calendar can create difficulties in transporting them and are therefore objectionable to some of the patients.The study concludes that the benefits of the MED calendar far outweigh the difficulties encountered in using this system of promoting and facilitating patient compliance

Indian Health Service chart series book April 1988

This publication presents tables and charts that describe the Indian Health Service program, and the health status of American Indians and Alaska Natives. Information pertaining to the IHS structure, American Indian and Alaska Native demography, patient care, and community health are included. Current and trend information are presented, and comparisons to other population groups are made, when appropriate

Alcoholism: a high priority health problem

This report summarizes the problem and the historical background of alcoholism, evaluates prevention programs, and offers a reference guide for tribes and communities wishing to undertake alcoholism projects