ARRA ACTION: Comparative Effectiveness of Health Care Delivery Systems for American Indians and Alaska Natives Using Enhanced Data Infrastructure

Final Report

Prepared for:
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.


Executive Summary
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
   Data Measures
Chapter 4. Factors to Consider when Analyzing Data for Multiple Project Sites
Chapter 5. Project Findings for Goal 1
   Demographic Results
   Health Coverage
   Health Status
   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
   Clinical 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


Appendix A.AHRQ/IHS Improving Health Care Delivery Data Project. Methods
Appendix B. Patient age, health status, and IHS total treatment costs by diabetes stage. Fiscal year 2010


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


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.

Page last reviewed December 2017
Page originally created May 2014
Internet Citation: ARRA ACTION: Comparative Effectiveness of Health Care Delivery Systems for American Indians and Alaska Natives Using Enhanced Data Infrastructure. Content last reviewed December 2017. Agency for Healthcare Research and Quality, Rockville, MD.