Trends in quality of care and barriers to improvement in the Indian Health Service

Thomas D. Sequist, Theresa Cullen, Kenneth Bernard, Shimon Shaykevich, E. John Orav, John Z. Ayanian

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Although Native Americans experience substantial disparities in health outcomes, little information is available regarding healthcare delivery for this population. OBJECTIVE: To analyze trends in ambulatory quality of care and physician reports of barriers to quality improvement within the Indian Health Service (IHS). DESIGN: Longitudinal analysis of clinical performance from 2002 to 2006 within the IHS, and a physician survey in 2007. PARTICIPANTS: Adult patients cared for within the IHS and 740 federally employed physicians within the IHS. MAIN MEASURES: Clinical performance for 12 measures of ambulatory care within the IHS; as well as physician reports of ability to access needed health services and use of quality improvement strategies. We examined the correlation between physician reports of access to mammography and clinical performance of breast cancer screening. A similar correlation was analyzed for diabetic retinopathy screening. KEY RESULTS: Clinical performance significantly improved for 10 of the 12 measures from 2002 to 2006, including adult immunizations, cholesterol testing, and measures of blood pressure and cholesterol control for diabetes and cardiovascular disease. Breast cancer screening rates decreased (44% to 40%, p=0.002), while screening rates for diabetic retinopathy remained constant (51%). Fewer than half of responding primary care physicians reported adequate access to high-quality specialists (29%), non-emergency hospital admission (37%), high-quality imaging services (32%), and high-quality outpatient mental health services (16%). Breast cancer screening rates were higher at sites with higher rates of physicians reporting routine access to mam-mography compared to sites with lower rates of physicians reporting such access (46% vs. 35%, ρ=0.27, p= 0.04). Most physicians reported using patient registries and decision support tools to improve patient care. CONCLUSIONS: Quality of care has improved within the IHS for many services, however performance in specific areas may be limited by access to essential resources.

Original languageEnglish (US)
Pages (from-to)480-486
Number of pages7
JournalJournal of general internal medicine
Volume26
Issue number5
DOIs
StatePublished - May 1 2011
Externally publishedYes

Fingerprint

United States Indian Health Service
Quality of Health Care
Physicians
Ambulatory Care
Early Detection of Cancer
Diabetic Retinopathy
Breast Neoplasms
Quality Improvement
Cholesterol
Aptitude
North American Indians
Mental Health Services
Primary Care Physicians
Mammography
Health Services
Registries
Immunization
Patient Care
Cardiovascular Diseases
Blood Pressure

Keywords

  • American Indian
  • Indian Health Service
  • Native American
  • Quality improvement
  • Quality of care
  • Racial disparities

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Trends in quality of care and barriers to improvement in the Indian Health Service. / Sequist, Thomas D.; Cullen, Theresa; Bernard, Kenneth; Shaykevich, Shimon; Orav, E. John; Ayanian, John Z.

In: Journal of general internal medicine, Vol. 26, No. 5, 01.05.2011, p. 480-486.

Research output: Contribution to journalArticle

Sequist, Thomas D. ; Cullen, Theresa ; Bernard, Kenneth ; Shaykevich, Shimon ; Orav, E. John ; Ayanian, John Z. / Trends in quality of care and barriers to improvement in the Indian Health Service. In: Journal of general internal medicine. 2011 ; Vol. 26, No. 5. pp. 480-486.
@article{b746ed481fbf4045bf141b3e1b808e81,
title = "Trends in quality of care and barriers to improvement in the Indian Health Service",
abstract = "BACKGROUND: Although Native Americans experience substantial disparities in health outcomes, little information is available regarding healthcare delivery for this population. OBJECTIVE: To analyze trends in ambulatory quality of care and physician reports of barriers to quality improvement within the Indian Health Service (IHS). DESIGN: Longitudinal analysis of clinical performance from 2002 to 2006 within the IHS, and a physician survey in 2007. PARTICIPANTS: Adult patients cared for within the IHS and 740 federally employed physicians within the IHS. MAIN MEASURES: Clinical performance for 12 measures of ambulatory care within the IHS; as well as physician reports of ability to access needed health services and use of quality improvement strategies. We examined the correlation between physician reports of access to mammography and clinical performance of breast cancer screening. A similar correlation was analyzed for diabetic retinopathy screening. KEY RESULTS: Clinical performance significantly improved for 10 of the 12 measures from 2002 to 2006, including adult immunizations, cholesterol testing, and measures of blood pressure and cholesterol control for diabetes and cardiovascular disease. Breast cancer screening rates decreased (44{\%} to 40{\%}, p=0.002), while screening rates for diabetic retinopathy remained constant (51{\%}). Fewer than half of responding primary care physicians reported adequate access to high-quality specialists (29{\%}), non-emergency hospital admission (37{\%}), high-quality imaging services (32{\%}), and high-quality outpatient mental health services (16{\%}). Breast cancer screening rates were higher at sites with higher rates of physicians reporting routine access to mam-mography compared to sites with lower rates of physicians reporting such access (46{\%} vs. 35{\%}, ρ=0.27, p= 0.04). Most physicians reported using patient registries and decision support tools to improve patient care. CONCLUSIONS: Quality of care has improved within the IHS for many services, however performance in specific areas may be limited by access to essential resources.",
keywords = "American Indian, Indian Health Service, Native American, Quality improvement, Quality of care, Racial disparities",
author = "Sequist, {Thomas D.} and Theresa Cullen and Kenneth Bernard and Shimon Shaykevich and Orav, {E. John} and Ayanian, {John Z.}",
year = "2011",
month = "5",
day = "1",
doi = "10.1007/s11606-010-1594-4",
language = "English (US)",
volume = "26",
pages = "480--486",
journal = "Journal of General Internal Medicine",
issn = "0884-8734",
publisher = "Springer New York",
number = "5",

}

TY - JOUR

T1 - Trends in quality of care and barriers to improvement in the Indian Health Service

AU - Sequist, Thomas D.

AU - Cullen, Theresa

AU - Bernard, Kenneth

AU - Shaykevich, Shimon

AU - Orav, E. John

AU - Ayanian, John Z.

PY - 2011/5/1

Y1 - 2011/5/1

N2 - BACKGROUND: Although Native Americans experience substantial disparities in health outcomes, little information is available regarding healthcare delivery for this population. OBJECTIVE: To analyze trends in ambulatory quality of care and physician reports of barriers to quality improvement within the Indian Health Service (IHS). DESIGN: Longitudinal analysis of clinical performance from 2002 to 2006 within the IHS, and a physician survey in 2007. PARTICIPANTS: Adult patients cared for within the IHS and 740 federally employed physicians within the IHS. MAIN MEASURES: Clinical performance for 12 measures of ambulatory care within the IHS; as well as physician reports of ability to access needed health services and use of quality improvement strategies. We examined the correlation between physician reports of access to mammography and clinical performance of breast cancer screening. A similar correlation was analyzed for diabetic retinopathy screening. KEY RESULTS: Clinical performance significantly improved for 10 of the 12 measures from 2002 to 2006, including adult immunizations, cholesterol testing, and measures of blood pressure and cholesterol control for diabetes and cardiovascular disease. Breast cancer screening rates decreased (44% to 40%, p=0.002), while screening rates for diabetic retinopathy remained constant (51%). Fewer than half of responding primary care physicians reported adequate access to high-quality specialists (29%), non-emergency hospital admission (37%), high-quality imaging services (32%), and high-quality outpatient mental health services (16%). Breast cancer screening rates were higher at sites with higher rates of physicians reporting routine access to mam-mography compared to sites with lower rates of physicians reporting such access (46% vs. 35%, ρ=0.27, p= 0.04). Most physicians reported using patient registries and decision support tools to improve patient care. CONCLUSIONS: Quality of care has improved within the IHS for many services, however performance in specific areas may be limited by access to essential resources.

AB - BACKGROUND: Although Native Americans experience substantial disparities in health outcomes, little information is available regarding healthcare delivery for this population. OBJECTIVE: To analyze trends in ambulatory quality of care and physician reports of barriers to quality improvement within the Indian Health Service (IHS). DESIGN: Longitudinal analysis of clinical performance from 2002 to 2006 within the IHS, and a physician survey in 2007. PARTICIPANTS: Adult patients cared for within the IHS and 740 federally employed physicians within the IHS. MAIN MEASURES: Clinical performance for 12 measures of ambulatory care within the IHS; as well as physician reports of ability to access needed health services and use of quality improvement strategies. We examined the correlation between physician reports of access to mammography and clinical performance of breast cancer screening. A similar correlation was analyzed for diabetic retinopathy screening. KEY RESULTS: Clinical performance significantly improved for 10 of the 12 measures from 2002 to 2006, including adult immunizations, cholesterol testing, and measures of blood pressure and cholesterol control for diabetes and cardiovascular disease. Breast cancer screening rates decreased (44% to 40%, p=0.002), while screening rates for diabetic retinopathy remained constant (51%). Fewer than half of responding primary care physicians reported adequate access to high-quality specialists (29%), non-emergency hospital admission (37%), high-quality imaging services (32%), and high-quality outpatient mental health services (16%). Breast cancer screening rates were higher at sites with higher rates of physicians reporting routine access to mam-mography compared to sites with lower rates of physicians reporting such access (46% vs. 35%, ρ=0.27, p= 0.04). Most physicians reported using patient registries and decision support tools to improve patient care. CONCLUSIONS: Quality of care has improved within the IHS for many services, however performance in specific areas may be limited by access to essential resources.

KW - American Indian

KW - Indian Health Service

KW - Native American

KW - Quality improvement

KW - Quality of care

KW - Racial disparities

UR - http://www.scopus.com/inward/record.url?scp=79958235162&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79958235162&partnerID=8YFLogxK

U2 - 10.1007/s11606-010-1594-4

DO - 10.1007/s11606-010-1594-4

M3 - Article

C2 - 21132462

AN - SCOPUS:79958235162

VL - 26

SP - 480

EP - 486

JO - Journal of General Internal Medicine

JF - Journal of General Internal Medicine

SN - 0884-8734

IS - 5

ER -