We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Trends in quality of care and barriers to improvement in the Indian Health Service.
- Authors
Sequist, Thomas D.; Cullen, Theresa; Bernard, Kenneth; Shaykevich, Shimon; Orav, E. John; Ayanian, John Z.
- Abstract
<bold>Background: </bold>Although Native Americans experience substantial disparities in health outcomes, little information is available regarding healthcare delivery for this population.<bold>Objective: </bold>To analyze trends in ambulatory quality of care and physician reports of barriers to quality improvement within the Indian Health Service (IHS).<bold>Design: </bold>Longitudinal analysis of clinical performance from 2002 to 2006 within the IHS, and a physician survey in 2007.<bold>Participants: </bold>Adult patients cared for within the IHS and 740 federally employed physicians within the IHS.<bold>Main Measures: </bold>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.<bold>Key Results: </bold>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 mammography 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.<bold>Conclusions: </bold>Quality of care has improved within the IHS for many services, however performance in specific areas may be limited by access to essential resources.
- Subjects
UNITED States; MEDICAL quality control; HEALTH of Native Americans; UNITED States. Indian Health Service; DIABETIC retinopathy; OUTPATIENT medical care; OUTPATIENT mental health facilities; QUALITY assurance standards; CLINICAL competence; COMPARATIVE studies; HEALTH services accessibility; HEALTH status indicators; NATIVE Americans; LONGITUDINAL method; RESEARCH methodology; MEDICAL cooperation; QUALITY assurance; RESEARCH; RESEARCH funding; MEDICAL care of indigenous peoples; EVALUATION research; ACQUISITION of data
- Publication
JGIM: Journal of General Internal Medicine, 2011, Vol 26, Issue 5, p480
- ISSN
0884-8734
- Publication type
journal article
- DOI
10.1007/s11606-010-1594-4