Acrobat
MS Word
PowerPoint
Volume 6, No. 9, September 2008
From Your Colleagues
Donald Berwick, Institute for Healthcare Improvement
“A transatlantic review of the NHS at 60”
Cynics beware, I am romantic about the National Health Service; I love it. All I need to do to rediscover the romance is to look at health care in my own country.
The NHS is one of the astounding human endeavours of modern times. Because you use a nation as the scale and taxation as the funding, the NHS is highly political. It is a stage for the polarising debates of modern social theory: debates between market theorists and social planning; enlightenment science and post-modern sceptics of science; utilitarianism and individualism; the premise that we are all responsible for each other and the premise that we are each responsible for ourselves; those for whom government is a source of hope and those for whom government is hopeless. But, even in these debates, you are unified by your nation’s promise to make health care a human right…
CCC Editorial Comment:
Above is the first paragraph of a personal paper published in the British Medical Journal in recognition of the 60th anniversary of the National Health Service of Great Britain. Dr. Berwick and the Institute for Healthcare Improvement have a longstanding and close collaboration with the Indian Health Service and are currently working on a large multisite project, “Innovations in Planned Care”.
Berwick DM. A transatlantic review of the NHS at 60. BMJ. 2008 Jul 17;337:a838. doi: 10.1136/bmj.a838. http://www.ncbi.nlm.nih.gov/pubmed/18640956
Ann Bullock, Cherokee, NC
Advances in Indian Health Conference
Save the Dates! The 2009 "Advances in Indian Health Conference" will be April 21-24, 2009 in Albuquerque, NM. "Advances" is Indian Health's conference for primary care providers and nurses. Get up to 28 hours of CME/CE credit learning about clinical topics of special interest to I/T/U providers, including the option to focus on diabetes training. To see the 2008 brochure, go to http://hsc.unm.edu/cme/2008Web/AdvancesIndianHealth/AIH2008Index.shtml or you can contact the Course Director, Dr. Ann Bullock at annbull@nc-cherokee.com for more information.
David Gahn, Kabul, Afghanistan
Afghanistan Update: Assistant Secretary for Health ADM Joxel Garcia, MD, FACOG visits Kabul
In July, our Assistant Secretary for Health,
ADM Joxel Garcia, spent four days in Kabul with the Indian Health Service team. Dr.
Garcia spent an entire day at Rabia Balkhi Hospital, the primary focus of our
efforts, and also spent time at other health care facilities in Kabul to get
a close-up view of the obstacles and opportunities HHS faces. Dr. Garcia,
a board certified Ob/Gyn, got a good look at the systems in place and spent time
interacting with the patients and hospital staff.
Dr. Garcia’s primary objective is to coordinate HHS’ efforts in Afghanistan
as many of our agencies our involved. Through meetings with the Afghanistan
Ministry of Public Health, the U.S. Ambassador to Afghanistan, the U.S. Department
of Defense, and the U.S. Agency for International Development Mission Director,
Dr. Garcia has brought all the players to the table as together the U.S. Government
completes a comprehensive health strategy for supporting our health diplomacy
and humanitarian missions in Afghanistan.
The IHS Clinical Team, composed of CDR David Gahn (Ob/Gyn, Tahlequah), CAPT Pat O’Connor (Peds, Tuba City), CDR. Mei Castor (Med Epi, Seattle), and LCDR James Dickens (FNP, Dallas CMS), spent 6 weeks working with the hospital staff in various aspects of clinical care. CDR Gahn and LCDR Dickens focused on surgical skills with the physicians and nurses and CAPT O’Connor focused on newborn care. CDR Castor completed a preliminary Patient Outcome Assessment (POA) where, with a team of Rabia Balkhi physicians, she tracked 26 patients from admission to discharge with further follow-up post discharge pending. Her work is in preparation for a comprehensive POA schedule for the month of October where the team will track every obstetrics patient that presents at Rabia Balkhi for the entire month collecting data on all the systems involved in patient care. This data will continue to guide us as we develop the Ob/Gyn Residency Program and work on the other hospital systems.
The team is scheduled for another 6 week deployment in September with the addition of CAPT Robert Branche (Anesthesia, Phoenix) to the team. Anesthesia services are a major contributor to the maternal and perinatal morbidity and mortality occurring at Rabia Balkhi and this will be the first comprehensive analysis performed by a U.S. trained anesthesiologist.
The Afghanistan Health Initiative appears to be secure in its funding for FY 09, and with the Dr. Garcia’s involvement in the project things are moving in a very positive direction. For information, please feel free to contact me at David.Gahn@IHS.gov.
Fabian Kennedy, Northern Plains Tobacco Prevention Program
Updated Website/Tobacco Control Activities Event Page
Our mission is to lead regional efforts to reduce addictive tobacco use and exposure to environmental tobacco smoke among American Indians residing in the Northern Plains.
The Northern Plains Tobacco Prevention
Project (NPTPP) is an initiative of the Aberdeen Area Tribal Chairmen’s
Health Board (AATCHB) to address commercial tobacco use among American Indians
residing in the Aberdeen Area (North Dakota, South Dakota, Nebraska, and Iowa).
NPTPP serves as a tribal support center assisting tribal communities and tribally-based
organizations to plan, implement, evaluate, and sustain tobacco prevention and
control programs.
NPTPP is committed to improving the health of American Indian communities through
promoting traditional concepts of health and well being and providing excellence
in tobacco prevention and control. If you are interested in learning more about
how to implement a tobacco cessation or prevention program, or would like to
learn more about how commercial (non-ceremonial) tobacco use is affecting Indian
Country, please contact us.
Please see our updated event page for tobacco control activities that are going on at the regional and national level as well as information on
- Prevention of commercial tobacco use among youth and pregnant women.
- Promotion of smoking cessation.
- Elimination of non-smokers exposure to secondhand smoke.
- Elimination of health disparities within Northern Plains tribal communities that are a result of commercial tobacco use.
Brigg Reilley, Albuquerque, NM
Indian Health Service Prenatal HIV Screening: Gaps and Best Practices
BACKGROUND: Prenatal
HIV screening is an important part of prenatal care. IHS
Prenatal HIV testing rates in 2005 were 54%.
METHODOLOGY: We reviewed 598 charts that had GPRA ‘misses’ (woman
in prenatal care who did not receive HIV screening) in 27 sites across IHS to
determine the cause of the ‘miss’. RESULTS: Most women
(52%) were not screened for HIV. While some women did not need to be screened
(declined test, or had a miscarriage), 167 (70%) of this group were missed opportunities. In
nearly half (48%) the misses the woman was screened for HIV but the data was
not recorded.
CONCLUSIONS: Most sites were unaware of the clinical and data gaps. Service
Units with the highest screening rates showed distinct ‘best practices’ such
as: 1) pregnant women were tested for HIV on the first visit they had an
HCG+, 2) HIV was bundled into a standardized prenatal lab screening panel, and
3) not requiring written consent for HIV testing. Many other data and clinical
practices and tips were provided during interviews with medical staff and recommendations
are listed in the article.
http://www.ihs.gov/Publicinfo/Publications/HealthProvider/issues/PROV0808.pdf
CCC Editorial Comment:
This is just one example of the Indian Health Service–specific information found in the IHS Primary Care Provider. You can subscribe to The Provider electronically.
To start your electronic subscription, go to The Provider website (http://www.ihs.gov/publicinfo/publications/healthprovider/provider.asp) and complete the subscription form.
If you would like to receive a paper copy by mail, e-mail Cheryl Begay at Cheryl.Begay@ihs.gov.
If you receive a paper copy now but would prefer to “go green”, send an e-mail to the.provider@ihs.gov asking to be removed from the mailing list.
Abstract Of The Month ‹ Previous | Next › Hot Topics
OB/GYN
Jean Howe, MD, MPH is the Obstetrics and Gynecology Chief Clinical Consultant (OB/GYN C.C.C.). Dr. Howe is very interested in establishing a dialogue and/or networking with anyone involved in women's health or maternal child health, especially as it applies to American Indian and Alaska Native women and also indigenous peoples around the world. Please don't hesitate to contact her by e-mail (jean.howe@ihs.gov) or phone at (928) 674-7422.
