文章基本信息

标题：Information Technology as a Tool to Improve the Quality of American Indian Health Care
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作者：Thomas D. Sequist ; Theresa Cullen ; John Z. Ayanian 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2005
卷号：95
期号：12
页码：2173-2179
DOI：10.2105/AJPH.2004.052985
语种：English
出版社：American Public Health Association
摘要：The American Indian/Alaska Native population experiences a disproportionate burden of disease across a spectrum of conditions. While the recent National Healthcare Disparities Report highlighted differences in quality of care among racial and ethnic groups, there was only very limited information available for American Indians. The Indian Health Service (IHS) is currently enhancing its information systems to improve the measurement of health care quality as well as to support quality improvement initiatives. We summarize current knowledge regarding health care quality for American Indians, highlighting the variation in reported measures in the existing literature. We then discuss how the IHS is using information systems to produce standardized performance measures and present future directions for improving American Indian health care quality. THE AMERICAN INDIAN population is experiencing a growing chronic disease burden. While the epidemic of diabetes is widely publicized, 1 ^– 3 American Indians also suffer from an increased incidence of coronary heart disease, cancer, influenza, pneumonia, and infant mortality. This disproportionate disease burden contributes to the American Indian population’s low median lifespan, which is 5 years shorter than among White Americans. 4 While the base of scientific evidence about how to improve patient outcomes is large and growing, practice has lagged behind substantially. Only 79% of patients with newly diagnosed diabetes receive appropriate glycemic monitoring, and only 55% undergo appropriate eye examinations. 5 Similar findings of underuse exist for cancer screening, vaccination, and a wide spectrum of other conditions. 6 The measurement and improvement of health care quality is a relatively recent imperative, 7 and there is currently limited information regarding quality of care for American Indians/Alaska Natives. The initial National Healthcare Disparities Report released in 2003, for example, was unable to provide reliable data for American Indians in many important areas, including receipt of influenza and pneumococcal vaccines and treatment of diabetes, coronary heart disease, and hypertension. 8 Information systems have been cited by the Institute of Medicine as an important quality improvement tool. 9 Many large integrated health care organizations, including Kaiser-Permanente Northern California 10 and the Veterans Health Administration, 11 have adopted the use of electronic information systems to improve quality. When used in combination with other quality improvement strategies, these efforts have resulted in remarkable improvements in quality of care. 12 The Indian Health Service (IHS) is well positioned as an integrated health system to use information systems to provide data both on the current state of health care quality for American Indians and to direct quality improvement efforts. In this article, we summarize the current state of health care quality for American Indians and describe ongoing efforts by the IHS to enhance its existing information technology infrastructure to support improved performance measurement. We then present case examples to illustrate how these systems can improve care and discuss barriers and future directions for quality improvement within the IHS.