Ambulatory care improvement demo project evaluation study.

The Outpatient Department (OPD) of the Alaska Native Medical Center in Anchorage, Alaska offers ambulatory health care services to Alaskan Natives throughout the state. The Outpatient Department focuses on acute and chronic care within the context of all hospital services offered at the Alaska Native Medical Center. Three areas of the OPD were targeted for examination: 1) consumer satisfaction with services provided; 2) identification of areas where Native regional corporations could provide assistance in the development of new programs; and 3) development of a model whereby the Indian Health Service and the Alaska Native Medical Center could work cooperatively with the Cook Inlet Native Association on a five year plan. The scope of the study included consumer satisfaction, a profile of consumer problems, a review of selected day-to-day operational issues, and a review of selected issues of concern to the provider staff. A consumer-oriented and responsive-naturalistic approach was used to evaluate the OPD. Because of the need to develop a cooperative relationship and the desire to address as many functional areas or issues as possible, the methodology for the study was quite subjective. After developing a working relationship with OPD staff, existing data on issues under study was collected and reviewed. Observations were then conducted where appropriate. Interviews were conducted as appropriate and findings were reviewed and analyzed in a series of meetings with study participants. An open-ended Consumer Satisfaction Opinion Poll was conducted in English by researchers with selected participants in the waiting room of the clinic. Additionally, a consumer-problem profile was developed by identifying utilization patterns through review of individual consumer charts. Five hundred sixty-five charts were reviewed by a physician\u27s assistant according to criteria established cooperatively by the study participants. Day-to-day operational issues identified by the study participants were also investigated by several consultants who observed activities and procedures. The recommendation with the highest priority was to add a modular unit to the present OPD and make an additional 2500 to 2700 square feet available. Cook Inlet Native Association recommended that this space be used for an appointment clinic, leaving the present OPD for an emergency and walk-in clinic. This appointment clinic would allow the OPD to adopt a family practice treatment mode. It was also recommended that future resources for ambulatory care should be expended in areas where an impact on Native health status could be expected to result. Further studies on the issues of health education, mental health, social services, and alcoholism, as they relate to ambulatory care services should be investigated. This Phase I study resulted in a broader understanding of the Outpatient Department on the part of the Native consumer and identified areas where improvements could be made