Research Highlights Important Progress in Improving Quality of Care Along with Barriers to Improvement in the Indian Health Service

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To assess IHS quality improvement programs that were initiated over the study period, researchers conducted the largest analysis to-date of American Indian health care and observed significant improvements in the quality of care across many clinical areas including preventive and chronic disease care.  However, researchers also found barriers to delivering high quality care that may be due to resource constraints within the system.  This research is published online and in an upcoming issue of the Journal of General Internal Medicine.

“Although there has been decades of research on racial disparities in health care, more research is needed to understand disparities in the American Indian and Alaska Native population,” said Thomas Sequist, MD, MPH, lead author of the research and a physician in the Division of General Medicine at BWH.  “A more in-depth understanding of the impact of ongoing quality improvement efforts and barriers to care is an important step to improving the health of the American Indian population.”

Researchers evaluated clinical performance data for 12 measures of health care from 2002 to 2006 using information from the IHS national electronic medical record system.  They combined this with results from a physician survey completed in 2007 on access to health services and quality improvement strategies.  Clinical performance improved substantially for a majority of clinical indicators, including those for diabetes care, heart disease care, and immunizations.  However, physicians reported barriers to accessing many essential health services including specialist consultations and mental health care, for which resources are limited.

“The IHS, which serves approximately half of the American Indian population, has a per person budget that is substantially less than all other federal health care programs.  This can contribute to important constraints in the clinical setting.  For example, in the IHS only 29 percent of primary care physicians report adequate access to specialists; compared to studies that reveal 76 percent of primary care physicians have such access in the private sector,” Sequist said.

The BWH Outreach Program with the IHS is a physician volunteer program that aims to address the disparities American Indians face specifically related to the lack of access to specialty care.  Physician specialists from BWH volunteer their time to travel to IHS hospitals serving the Navajo reservation in Gallup and Shiprock, New Mexico. Physicians provide a mix of direct patient care and education for local medical staff through lectures and skills-based training sessions across many areas including surgery, cardiology, dermatology, rheumatology and many other fields.  Once the physicians return to BWH, they continue with the program through remote teaching and consultation services from Boston via telemedicine technology.

The IHS has made important strides in improving care among American Indian communities in the past decade.  Researchers acknowledge that the overall health of the American Indian population may be further improved by effective use of new resources to improve access to appropriate care.

This research was funded by the Robert Wood Johnson Foundation and Harvard Catalyst.

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