ARRA ACTION: Comparative Effectiveness of Health Care Delivery Systems for American Indians and Alaska Natives Using Enhanced Data Infrastructure
Agency for Healthcare Research and Quality
U.S. Department of Health and Human Services
540 Gaither Road
Rockville, MD 20850
Contract No. 290-2006-00020-I, TO #11
Prepared by: Denver Health, Denver, CO
Authors: Joan O’Connell, Ph.D.; Soyeon Guh, Ph.D.; Judith Ouellet, M.P.H.; Jennifer Rockell, Ph.D.; Yaqiang Li, M.P.H.; Calvin Croy, Ph.D.; and Margaret Gutilla, M.S.
Chapter 1. Project Overview
Chapter 2. Project Implementation
IHS Improving Health Care Delivery Data Project Collaboration
Project Implementation Timeline and Milestones
Chapter 3. Development of the Data Infrastructure
Overview of Data Infrastructure Development
Development of Specific Data Files for the Data Mart
Chapter 4. Factors to Consider when Analyzing Data for Multiple Project Sites
Chapter 5. Project Findings for Goal 1
Health Service Utilization
Utilization of Hospital Inpatient Services
Utilization of Outpatient Services and Prescribed Medications
IHS Total Treatment Costs
Chapter 6. Project Findings for Goal 2
Education and Case Management Services
Utilization of Education and Case Management Services
Characteristics Associated with Use of Education and Case Management Services
Chapter 7. Discussion of Project Findings
Chapter 8. Lessons Learned and Suggestions for Data Enhancements
General Lessons Learned
Suggestions for Modifications to the National Data Warehouse
Service Utilization Measures
Suggestions for Increasing Access to and Use of Existing Electronic Data
Chapter 9. Potential Future Uses of the Data Infrastructure
Project 1: Longitudinal CER Study of the Influence of ECM Service Use on Health Outcomes
Project 2: Examine Utilization, Outcomes, and Costs of Advanced Practice Pharmacy Services
Project 3: Assessing Clinical Opportunities for Improving Health Outcomes
Project 4: Assessing Pharmacy Utilization
Project 5: Assessing the influence of the IPC model on utilization of ED and hospital inpatient services
This project was funded by the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services. The opinions expressed in this document are those of the authors and do not reflect the official position of AHRQ or the U.S. Department of Health and Human Services.
None of the investigators has any affiliations or financial involvement that conflicts with the material presented in this report.
This document is in the public domain and may be used and reprinted without permission except those copyrighted materials that are clearly noted in the document. Further reproduction of those copyrighted materials is prohibited without the specific permission of copyright holders.
This project was funded as an Accelerating Change and Transformation in Organizations and Networks (ACTION) task order contract. ACTION is a 5-year implementation model of field-based research that fosters public-private collaboration in rapid-cycle, applied studies. ACTION promotes innovation in health care delivery by accelerating the development, implementation, diffusion, and uptake of demand-driven and evidence-based products, tools, strategies, and findings. ACTION also develops and diffuses scientific evidence about what does and does not work to improve health care delivery systems. It provides an impressive cadre of delivery-affiliated researchers and sites with a means of testing the application and uptake of research knowledge. With a goal of turning research into practice, ACTION links many of the Nation's largest health care systems with its top health services researchers. For more information about this initiative, go to http://www.ahrq.gov/research/findings/factsheets/translating/action/index.html.
Agency for Healthcare Research and Quality (AHRQ) funding supported personnel at the Centers for American Indian and Alaska Native Health, at the Colorado School of Public Health, and at Denver Health to implement the project. However, this project would not have been possible without the collaboration and contributions of Indian Health Service (IHS) and Tribal health personnel, members of the project’s Steering Committee who represented other Native organizations, and our project consultants. We would like to acknowledge the contributions of IHS personnel from the Pharmacy Program (Principal Pharmacy Consultant, Capt. Chris Watson, R.Ph., M.P.H., CDR), the Division of Diabetes Treatment and Prevention (Acting Directors Lorraine Valdez, R.N., B.S.M., M.P.A. and Ann Bullock, M.D.), the Office of Information Technology, and the Office of Public Health Support, as well as CDR Sherri Yoder, Pharm.D., BCPS, the AHRQ-IHS Liaison. We would also like to acknowledge Sue Ehrhart, from Eyak Technology, LLC, for her assistance with extracting and understanding data from the IHS National Data Warehouse. Invaluable expertise and advice were provided by our project consultants, including Dr. Charlton Wilson; Dr. Rong Yi from Milliman; and Peggy Sheets, Jim Lamont, and Phil Barry, who are financial consultants from the EighteenNineteen Group, Inc. Lastly, this project would not have been feasible without the critical guidance and advice provided by representatives of each of the 14 IHS Service Units who collaborated with us on the project.