Addressing Critical Concerns of Healthcare Systems Serving American Indians/Alaska Natives

Using Measurement to Meet Need

Presenters: Michael Gomez (Laguna Pueblo), Program Manager, Indian Health Performance Evaluation System, Phoenix Area Indian Health Service (IHS), U.S. Department of Health and Human Services, Albuquerque, NM. Trula A. Breuninger, M.P.H. (Navajo), Project Director, Indian Community Health Profile Project, Northwest Tribal Epidemiology Center (The EpiCenter), Northwest Portland Area Indian Health Board, Portland, OR. Richard T. Haverkate, M.P.H. (Sault Ste. Marie Tribe of Chippewa), Health Services Director, Inter-Tribal Council of Michigan, Inc., Sault Ste. Marie, MI.

Why Measure and Evaluate Data?

Compelling reasons exist for health facilities with limited resources to devote some of those resources to measuring and evaluating data. Data collection and analysis will help:

• Improve patient care: Statistics on activities performed will indicate why people are coming to the facility in the first place, productivity, service volume, intensity of services, and unit costs.
• Improve public health: Vital statistics and community-specific studies or surveys will provide information on the prevalence of specific diseases or behaviors.
• Better manage and improve quality: Patient care statistics and studies on performance can show the quality of care and services provided. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO), a private, nonprofit accrediting entity, requires participation in ORYX data analysis system as part of accreditation.
• Obtain funding: Many third-party reimbursement sources—including Medicaid, Medicare, and IHS—require that the facility collect performance data. Moreover, data may help "make the case" to private funders.
• Improve planning: All information analyzed can be used to prioritize needed services and point to areas where efficiency and effectiveness could be increased. Once baseline information has been gathered, facilities can periodically reassess to see if either process or outcomes are improving.

Indian Community Health Profile

The Indian Community Health Profile has been developed by the Northwest Portland Area Indian Health Board, Northwest Tribal Epidemiology Center, to be a useful, usable, and valid way for tribal communities of 1,000 to 5,000 members to assess and monitor their health status. Developed by tribal leaders and public health experts over a 2-year period, the profile is designed to enable an individual community to get more involved in the assessment of its health status and needs.

The profile uses 15 measures, trying to cover all the important measures of health. Tribes can collect and analyze data on all 15 indicators or select certain focus areas. The indicators fall into several broad domains:

• Sociodemographic indicators, such as educational attainment and family structure.
• Health-status indicators, such as prevalence of diabetes, rate of hospitalization for injuries, and prevalence of tooth decay in children.
• Mental health and functional-status indicators, such as the average number of healthy days for adults.
• Health risk factors and positive health behavior indicators, such as prevalence of childhood obesity, use of prenatal care, use of preventive services and screenings, substance abuse, prevalence of physical activity among adults, and number of confirmed cases of child abuse and neglect.
• Environmental indicators, such as the presence of tribal ordinances requiring auto safety restraint use.

Currently, three to five communities are being chosen to pilot the profile for 2 years. Selection criteria for the pilot sites include broad support (the communities must be involved in the decision to undertake the Profile process and in choosing the indicators) and small size of the community. Pilot communities will receive close support and technical assistance from the project staff. Once the instrument is pilot-tested, a new model will be available.

Michigan Tribal Community Profiling Project

The Michigan Tribal Community Profiling Project, facilitated by the Inter-Tribal Council of Michigan, Inc., is a 3-year project designed to aid tribal communities in developing their own health profiles by providing technical assistance in data collection, analysis, monitoring, and reporting. The steps in developing a community profile include:

• Decide how the profile will be used, e.g., to educate the community, to advocate for change, to begin program planning, to write grants, or to share with local/State/national agencies.
• Determine what types of data are needed for the profile to meet these goals. (Types of information have been mentioned above.)
• Find existing databases and information sources, as well as collecting primary data where none exists. For example, Rick Haverkate encouraged making connections with State Vital Statistics staff, as they have access to very useful information and resources. He noted that it will take a great deal of effort at the start to locate the "right person," but the effort pays off. He suggested face-to-face meetings as a way to build relationships.
• Find some help, particularly technical assistance and training on the use of software, data entry/retrieval, data interpretation, and presentation design.

The process and findings of the Sault Ste. Marie Tribe of Chippewa Indians' Community Profile were provided as an example.

• Demographic data showed that the tribe's population was much younger than the population of Michigan as a whole.
• Vital statistics data showed that injuries were the greatest cause of premature death among tribal members.
• Comparing the rates of years of potential life lost (YPLL, or the number of years lost among persons who die before age 65) between tribal members and white people in the same geographic area showed that the YPLL rate for tribal members was almost double that of white persons.
• This information was shared with tribal directors; the consensus of tribal leaders was to develop injury prevention programs.

References

From quality measures to quality care: examples of quality improvement at work. Rockville (MD): Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services; 1999. http://www.ahrq.gov/qual/21stcenb.htm

The Indian community health profile: an instrument for assessing the overall health status of American Indian and Alaska Native communities. Portland (OR): Northwest Portland Area Indian Health Board, Northwest Tribal Epidemiology Center; 2000.

Roe KM. Evaluation methodologies with limited resources. Washington (DC): Academy for Educational Development; 1997 Jan.

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