Office of the Assistant Secretary for Planning and Evaluation
	Policy Information Center

INDIAN HEALTH SERVICES

MISSION: The mission of the Indian Health Service, in partnership with American Indian and Alaska Native people, is to raise their physical, mental, social, and spiritual health to the highest level.

Evaluation Program

The goal of the Indian Health Service (IHS) is to assure that comprehensive, culturally acceptable, personal and public health services are available and accessible to American Indian and Alaska Native people. The importance of evaluation in supporting this goal has increased significantly in recent years and includes American Indians and Alaska Natives as the primary stakeholders in defining the purpose, design, and execution of evaluations. The stakeholders use the end product of the evaluations, and are typically the population or groups most likely to be affected by the evaluation findings. The IHS has formally adopted the principles of a responsive evaluation practice to address the needs and concerns of American Indians and Alaska Natives.

The evaluation program of the IHS is managed by the Office of Public Health, Staff Office of Planning, Evaluation, and Research (OPH-SOPER), which provides national leadership and consultation for IHS and Area Offices on strategic and tactical planning, program evaluation and assessment, public health and medical services, research agendas, and special public health initiatives for the Agency. The OPH-SOPER serves as the principal advisory office on issues of national health policy and coordinates the following four evaluation functions.

• Health Program Evaluations - Collect and analyze information useful for assisting IHS officials in determining the need for improving existing programs or creating new programs to address health needs.
• Policy Analysis - Conduct analyses when a change in the IHS health service delivery system must be considered, when issues emerge in an area where no policy currently exists, or when current policies are perceived as inappropriate or ineffective.
• Health Services Research - Undertake analyses of the organization, financing, administration, effects, and other aspects of the IHS delivery of health services.
• Special Studies and Initiatives - Conduct studies and prepare special reports required by Congress in response to pending legislation or policies, often using a roundtable, whenever an issue or a health problem requires immediate action and it is unclear what type of action should be taken.

The evaluation needs of the IHS service components are coordinated by OPH-SOPER using two major types of short-term studies: policy assessments and program evaluation studies. The IHS policy assessments contribute to decision making about budget, legislation, and program modifications and include background information to support the Agency's initiatives. Evaluation studies are focused at the program level, or Area Offices, and focus on specific program needs.

Each year OPH-SOPER selects high-priority health care and management studies for funding through the submission of proposals to headquarters and Area Offices. These proposals are reviewed and rated by a panel of subject-matter experts, evaluation experts, and IHS staff for concurrence with IHS strategic goals, objectives, and priority areas. The proposals are then prioritized and forwarded to the IHS Director, who reviews the projects that are recommended for funding and determines the respective funding levels.

In-Progress Evaluations Alaska Native Teen Tobacco American Indian Family Caregivers and the Provision of Long-Term Care Concurrent Evaluation of the Elders Clinic, a Multidisciplinary Geriatric Assessment Clinic at the Zuni-Ramah Service Unit Continuation and Completion of a Study to Analyze Quality Assurance and HP/DP Monitoring, and Analyze Methods Using Patient Care Component Dental Caries in Preschool Children Eastern Band of Cherokee Indian Health Care Delivery System Assessment Effectiveness of Evaluation of Systematic Implementation of Clinical Prevention Protocols for Chronic Disease Risk Reduction Evaluating the Effects of Medical Nutrition Therapy on Patient Outcomes Among Native Americans with Newly Diagnosed Type II Diabetes Mellitus Evaluating the Impact of Primary Intervention Techniques on the Dental Caries Rate in Children Living in Southwest Alaska Native Villages Evaluation of the Behavioral Risk Factor Surveillance System's Results and Their Applicability to the Native Population of Anchorage Hyperlipidemia and Coronary Heart Disease (CHD) in Native Americans: Evaluation of Lipid Control Through a Pharmacist Managed Lipid Clinic Impact of a Structured, Comprehensive, Multi-Disciplinary Patient Education Initiative--Year 2 Impact of Breast-feeding Education Program on Rates in the Early Postpartum Period and on Duration of Breast-feeding Year 2 Infant/Child Restraint Usage and Program Effectiveness Mental Health Service Delivery Model for Urban Native Americans: An Evaluation of Utilization Rates and Mental Health Treatment Factors Program Assessment of Co-Morbidity of Chemical Dependency Mental Health and Diabetes Pueblo of Zuni End Stage Renal Disease (ESRD) Quality of Life Survey Resource Requirements Methodology Update Study of the Impact of a Full-Time Community Health Nurse on the Health of Native American (Sioux) Patients with Hypertension & Prevention of and Education Cerebrovascular, Cardiovascular and Renal Disease Study of the Interaction of Persons Treated for Alcoholism with the Health Care Delivery System Utilizing the Indian-Specific Health Risk Assessment to Evaluate Community Health Promotion/Disease Prevention Programs

Alaska Native Teen Tobacco

The purpose of the Alaska Native Teen Tobacco Cessation Project is to (1) help the youth who participate in the project to quit tobacco; (2) motivate the youth to become tobacco prevention and cessation advocates in their communities; (3) determine the effectiveness of cessation camp model in helping youth to quit tobacco. If successful, further application of this model would be promoted. This is a three year project.

EXPECTED DATE OF COMPLETION: 12/30/2002

AGENCY SPONSOR: Office of Public Health

FEDERAL CONTACT: Elizabeth A. Fowler, 301-443-3024

PIC ID: 7128

PERFORMER: Indian Health Service, Rockville MD

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American Indian Family Caregivers and the Provision of Long-Term Care

This project is intended to help develop economically feasible and culturally acceptable long-term care modalities to support Native American families in delivering care to frail elders.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Office of Public Health

FEDERAL CONTACT: Elizabeth A. Fowler, 301-443-3024

PIC ID: 5940

PERFORMER: Indian Health Service, Office of Planning, Evaluation, and Legislation, Rockville MD 20857

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Concurrent Evaluation of the Elders Clinic, a Multidisciplinary Geriatric Assessment Clinic at the Zuni-Ramah Service Unit

The purpose of this study is to describe the epidemiologic surveillance capacity of the Indian Health Design Team Indian Health Service (IHS) Provider of Health Care/Tribal Provider of Health Care/Urban Indian Program Provider of Health Care (I/T/U) system. It will also make recommendations as to how the clinical capacity could be improved to better meet the needs of the IHS and its stakeholders. This study is of increasing importance as fewer Federal resources will be available to conduct epidemiologic surveillance.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Office of Public Health

FEDERAL CONTACT: Elizabeth A. Fowler, 301-443-3024

PIC ID: 6741

PERFORMER: Indian Health Service

Rockville MD

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Continuation and Completion of a Study to Analyze Quality Assurance and HP/DP Monitoring, and Analyze Methods Using Patient Care Component

This study will analyze quality assurance (QA) and health promotion and disease prevention (HP/DP) monitoring and analysis methods using the Patient Care Component (PCC) and Resource and Patient Management Systems (RPMS). These systems are currently in use at the Indian Health Service (IHS) facilities in the Billings area. The project goal is to improve the health status of Indians living in the Billings area by using the PCC database to monitor quality assurance activities and HP/DP objectives, while improving the database's accuracy and completeness.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Office of Public Health

FEDERAL CONTACT: Elizabeth A. Fowler, 301-443-3024

PIC ID: 5018

PERFORMER: IHS Billings Area Office

Billings MT

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Dental Caries in Preschool Children

This project will determine the existance of a Baby Bottle Tooth Decay (BBTD) pattern among preschool children clusters in families. It will also determineif dental nutrition education to families with one child with BBTD pattern caries will reduce the rate in susequent children. Project data will be used to determine the utility of providing family-directed dental and nutrition education can reduce BBTD clusters in families.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Office of Public Health

FEDERAL CONTACT: Elizabeth A. Fowler, 301-443-3024

PIC ID: 5531

PERFORMER: Indian Health Service

Rockville MD

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Eastern Band of Cherokee Indian Health Care Delivery System Assessment

This study will provide the Eastern Band of Cherokees with relative data on their current health care service delivery system. This data is intended for use in a re-design of the system so that it can be more responsive to all client and tribal member needs.

EXPECTED DATE OF COMPLETION:09/01/2001

AGENCY SPONSOR: Office of Public Health

FEDERAL CONTACT: Elizabeth A. Fowler, 301-443-3024

PIC ID: 6408

PERFORMER: Nashville Area Indian Health Service

Nashville TN

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Effectiveness of Evaluation of Systematic Implementation of Clinical Prevention Protocols for Chronic Disease Risk Reduction

This project will address health prevention and the reduction of chronic disease complications through development of a tracking system for use by the physicians and patients. This tracking system will serve as a model for tribes with health contracts.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Office of Public Health

FEDERAL CONTACT: Elizabeth A. Fowler, 301-443-3024

PIC ID: 5938

PERFORMER: Nashville Area Indian Health Service

Nashville TN

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Evaluating the Effects of Medical Nutrition Therapy on Patient Outcomes Among Native Americans with Newly Diagnosed Type II Diabetes Mellitus

This study will: (1) evaluate the effectiveness of medical nutrition therapy (MNT) on clinical/behavioral outcomes in American Indians/Alaska Natives (AI/AN) with newly diagnosed Type II diabetes, (2) create a uniform methodology for collecting nutrition-oriented outcome data that is consistent among participating tribes, service units and urban programs, (3) analyze the type and amount of MNT provided with regard to patient outcomes, and (4) link this information with current clinical data from the IHS Diabetes Program which identifies Continuous Quality Improvement performance measures.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Office of Public Health

FEDERAL CONTACT: Elizabeth A. Fowler, 301-443-3024

PIC ID: 6746

PERFORMER: Indian Health Service

Rockville MD

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Evaluating the Impact of Primary Intervention Techniques on the Dental Caries Rate in Children Living in Southwest Alaska Native Villages

This project will attempt to identify the reason why some communities in Bristol Bay have significantly higher/lower caries rates in children than do other children in other Bristol Bay communities. Children ages six to eight have been selected for the project, and the results of the project will be used to identify the factors that create high-risk communities. A community model will be developed for use in allocating specific resources to address the oral health needs of the villages. The primary activities will continue to be directed towards continuing intervention, which includes dental advocate services, tooth brushing, topical flouride and chemotherapy programs, distribution of children's books, and use of the medical model for dental treatment for one to eight year olds and their mothers.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Office of Public Health

FEDERAL CONTACT: Elizabeth A. Fowler, 301-443-3024

PIC ID: 7138

PERFORMER: Indian Health Service

Rockville MD

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Evaluation of the Behavioral Risk Factor Surveillance System's Results and Their Applicability to the Native Population of Anchorage

This study will determine the relative accuracy, validity and reliability of the Behavioral Risk Factor Surveillance System (BRFSS) risk estimates of the Anchorage Native population, compared with data collected using other techniques that include: (1) door-to-door household surveys, (2) key informant surveys, and (3) intercept data collection from Natives seeking primary care services in Anchorage from the Alaska Native Medical Center and the Primary Care Center. The analyses are revealing those particular risk factors that appear to be most significantly misrepresented by the BRFSS. This factor, combined with a more clinical analysis of those factors that pose the greatest risks to the health and well- being of the Native community, will be used in determining which questions to include on the key informant survey. Due to the nature of the survey, a relatively concise instrument is required, and only those items holding a high priority on one or both of the selection criteria (i.e., representation problems with the BRFSS and high clinical/medical risk) will be included in the key informant survey instrument.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Indian Health Service

FEDERAL CONTACT: Elizabeth A. Fowler, 301-443-3024

PIC ID: 7137

PERFORMER: Indian Health Service

Rockville MD

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Hyperlipidemia and Coronary Heart Disease (CHD) in Native Americans: Evaluation of Lipid Control Through a Pharmacist Managed Lipid Clinic

The purpose of this project is to evaluate the results of CV clinic coronary heart disease (CHD) risk management, counseling and aggressive medical nutritional therapy and pharmacological-therapeutic treatment of hyper-cholesterol in primary and secondary prevention in American Indian/Alaska Native (AI/AN) patients. The study will evaluate whether a pharmacist can effectively manage patients with dyslipidemias in comparison to usual care. In order to do this, the study will look at the proportion of patients enrolled in the CV clinic who meet target goals for total cholesterol, LDL cholesterol and triglycerides, compared to those receiving only the usual care. Secondly, the cost-effectiveness of the CV clinic will be evaluated. Lastly, changes in morbidity and mortality will be evaluated. If the findings of this evaluation show that the CV clinic is cost effective and successful in decreasing morbidity and mortality in the native population, this clinic could serve as a national prototype for other Indian Health Service (IHS) facilities.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Office of Public Health

FEDERAL CONTACT: Elizabeth A. Fowler, 301-443-3024

PIC ID: 7139

PERFORMER: Indian Health Service

Rockville MD

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Impact of a Structured, Comprehensive, Multi-Disciplinary Patient Education Initiative--Year 2

This study will: (1) promote wellness and prevent disease by providing comprehensive, accurate and understandable education to each patient, (2) study the impact of this multidisciplinary, planned patient education program on the health and wellness knowledge base of the patient population, and (3) document positive lifestyle/behavioral changes as a result of the education provided. The study population encompasses all American Indian/Alaska Native (AI/AN) patients eligible for care at the Service Unit (predominantly Cherokees). The Service Unit covers 12 counties in northeastern Oklahoma with 149,939 outpatient visits, accounting for 32,105 patients. This study will be submitted for publication in current medical journals by the Indian Health Service (IHS) provider. Information generated from this study will be disseminated to all tribes in the service area and all IHS facilities.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Office of Public Health

FEDERAL CONTACT: Elizabeth A. Fowler, 301-443-3024

PIC ID: 7140

PERFORMER: Indian Health Service

Rockville MD

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Impact of Breast-feeding Education Program on Rates in the Early Postpartum Period and on Duration of Breast-feeding Year 2

The purpose of this project is to study the effect of a specific, planned, consistent breast-feeding education program on rates of breast-feeding initiation, and on duration of breast-feeding in the patient population. The study population includes all live births at the Claremore Indian hospital for one year from the onset of the study. The control will be a historical control, and will consist of all live births in the year prior to the onset of the study, inclusive of March 1, 1997 to April 30, 1998. During this period there were 640 live births. The goal of the study will be to reach the Healthy People 2000 goal of having 75 percent of mothers initiating breast-feeding, and keeping 50 percent breast-feeding for five to six months.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Office of Public Health

FEDERAL CONTACT: Elizabeth A. Fowler, 301-443-3024

PIC ID: 7141

PERFORMER: Indian Health Service

Rockville MD

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Infant/Child Restraint Usage and Program Effectiveness

This project will determine (1) the effectiveness of Billings Area Indian Health Service (IHS) car seat programs; and (2) how to increase the use of carseats. Study subjects, mothers of children under three years old, will be recruited while in the hospital and at well-child clinics. Methods to increase awareness of the benefits of using car seasts will include "buckle-up" campaigns and encouraging tribal councils to pass and enforce seat belt ordinances.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Office of Public Health

FEDERAL CONTACT: Elizabeth A. Fowler, 301-443-3024

PIC ID: 5529

PERFORMER: Indian Health Service

Rockville MD

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Mental Health Service Delivery Model for Urban Native Americans: An Evaluation of Utilization Rates and Mental Health Treatment Factors

This project will address the Indian Health Service (IHS) mental health objective calling for a mental health care delivery system in urban areas. Results of the project will identify a potential model of mental health delivery applicable to urban areas.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Office of Public Health

FEDERAL CONTACT: Elizabeth A. Fowler, 301-443-3024

PIC ID: 5943

PERFORMER: California Area Indian Health Service

Sacramento, CA

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Program Assessment of Co-Morbidity of Chemical Dependency Mental Health and Diabetes

The purpose of this study is to determine outcome of simultaneous treatment of co-occurring chemical dependency, mental health issues and diabetes.

EXPECTED DATE OF COMPLETION:12/30/2001

AGENCY SPONSOR: Office of Public Health

FEDERAL CONTACT: Elizabeth A. Fowler

301-443-3024

PIC ID: 7029

PERFORMER: Indian Health Service

Rockville MD

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Pueblo of Zuni End Stage Renal Disease (ESRD) Quality of Life Survey

This study will assist the Pueblo of Zuni to measure the level of burden and quality life factors associated with end stage renal disease as it effects tribal members and their families.

EXPECTED DATE OF COMPLETION:09/01/2001

AGENCY SPONSOR: Office of Public Health

FEDERAL CONTACT: Elizabeth A. Fowler

301-443-3024

PIC ID: 6411

PERFORMER: Indian Health Service

Rockville MD

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Resource Requirements Methodology Update

This project will update the existing Resource Requirements Methodology (RRM) necessary to reflect current and future program demands of the Indian Health Service (IHS). A complete revision and documentation of the RRM will involve an update of staffing criteria and modules, formulation of a needs assessment cost model, and needs assessment model training.

EXPECTED DATE OF COMPLETION:09/29/2001

AGENCY SPONSOR: Office of Public Health

FEDERAL CONTACT: Elizabeth A. Fowler

301-443-3024

PIC ID: 6450

PERFORMER: Information and Management Technologies, Inc.

Silver Spring, MD

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Study of the Impact of a Full-Time Community Health Nurse on the Health of Native American (Sioux) Patients with Hypertension & Prevention and Education Cerebrovascular, Cardiovascular and Renal Disease

This project will study the impact of a full-time community health nurse on the detection and follow-up of hypertension within a specific Native American tribe, the Sioux. The impact of having a full-time community health nurse on the prevention of and education cerebrovascular, cardiovascular and renal disease within this population will also be examined.

EXPECTED DATE OF COMPLETION:09/01/2001

AGENCY SPONSOR: Office of Public Health

FEDERAL CONTACT: Elizabeth A. Fowler

301-443-3024

PIC ID: 6413

PERFORMER: Aberdeen Area Indian Health Service

Aberdeen, SD

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Study of the Interaction of Persons Treated for Alcoholism with the Health Care Delivery System

This project will study and evaluate the results of alcohol treatment for Indians who abuse alcohol. The primary physician will focus on the overall health care delivery system. The methodology issues will be worked out initially for the population served by the Crow Agency Service Unit. Data retrieval, audit instruments and analytical strategies will be piloted for one to two years. The methodology will be refined and used in all service units.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Office of Public Health

FEDERAL CONTACT: Elizabeth A. Fowler

301-443-3024

PIC ID: 6742

PERFORMER: Billings Area Indian Health Service

Billings, MT

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Utilizing the Indian-Specific Health Risk Assessment to Evaluate Community Health Promotion/Disease Prevention Programs

This project will: (1) produce a planning and assessment model for rural Alaska villages to develop a community behavior risk profile, (2) plan and implement appropriate intervention strategies, and (3) determine the impact of these interventions. It will collect baseline data through a community-wide health risk appraisal (HRA), and use model results to: (1) identify the most serious health risk behaviors, (2) plan appropriate interventions, (3) readminister the HRA in the community after a trial period to determine its impact, and (4) conduct a workshop for other communities to facilitate program replication.

EXPECTED DATE OF COMPLETION:09/30/2001

AGENCY SPONSOR: Office of Public Health

FEDERAL CONTACT: Elizabeth A. Fowler

301-443-3024

PIC ID: 4996

PERFORMER: Southeast Alaska Regional Health Corporation

Sitka, AK

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